Efficacy of Oral Racecadotril in Children with Acute Watery Diarrhea

Rida Tahir; Muhammad Tariq  Nadeem; Hira  Javed; Maryam  Ijaz

doi:10.51253/pafmj.v74i6.10039

Authors

Rida Tahir Department of Paediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Tariq Nadeem Department of Paediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Hira Javed Department of Paediatrics, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Maryam Ijaz Department of Paediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i6.10039

Keywords:

Acute Watery Diarrhea, Children, Efficacy, Racecadotril.

Abstract

Objective: To determine the efficacy of Racecadotril in treating acute watery diarrhea among children under 5 years of age attending Combined Military Hospital, Rawalpindi Pakistan.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Pediatrics, Combined Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2022.

Methodology: All patients aged 6 months to 5 years with acute watery diarrhea were consecutively enrolled. All children were randomly divided into a control group (Oral Rehydration Supplement) and a study group (Racecadotril 1.5 mg/kg every eight hours). Racecadotril administration lasted until diarrhea symptoms improved or five days after the start of the treatment. From day 1 to day 5, the quantity and consistency of stool were noted. On day 5, clinical effectiveness was indicated by three stools or fewer per day.

Results: Of 90 children, the overall efficacy was 61(67.8%). A significant association of efficacy was observed with the treatment group (p <0.001), degree of dehydration (p <0.001), and mother’s educational status (p 0.015). The efficacy was 4.82 times higher among children who received Racecadotril (aOR: 4.82, 95% CI 1.48-15.76), 3.21 times higher among intermediate or higher mothers’ education (aOR: 3.23, 95% CI 1.32-7.91), 2.84 times higher among below matric mothers’ education (aOR: 2.84, 95% CI 1.24-6.48) while 94% lower among children with severe dehydration (aOR: 0.06, 95% CI 0.01-0.27).

Conclusion: Racecadotril's efficacy was higher in treating children with acute watery diarrhea than Oral Rehydration Supplement alone in children under 5 years old.

Downloads

Download data is not yet available.

References

Liu L, Villavicencio F, Yeung D, Perin J, Lopez G, Strong KL, et al. National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis. Lancet Glob Health 2022; 10(3): e337-e347.

https://doi.org/10.1016/S2214-109X(21)00566-0

GBD 2016 Diarrheal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018; 18(11): 1211-1228.

https://doi.org/10.1016/S1473-3099(18)30362-1

Florez ID, Niño-Serna LF, Beltrán-Arroyave CP. Acute Infectious Diarrhea and Gastroenteritis in Children. Curr Infect Dis Rep 2020; 22(2): 4.

https://doi.org/10.1007/s11908-020-0713-6

Anigilaje EA. Management of Diarrheal Dehydration in Childhood: A Review for Clinicians in Developing Countries. Front Pediatr 2018; 6: 28.

https://doi.org/10.3389/fped.2018.00028

Santillanes G, Rose E. Evaluation and Management of Dehydration in Children. Emerg Med Clin North Am 2018; 36(2): 259-273. https://doi.org/10.1016/j.emc.2017.12.004

Liang Y, Zhang L, Zeng L, Gordon M, Wen J. Racecadotril for acute diarrhea in children. Cochrane Database Syst Rev 2019; 12(12): CD009359.

https://doi.org/10.1002/14651858.CD009359.pub2

Sultana A, Bishwas P, Islam S, Ghosh UK, Iman K, Afroze S, et al. Role of Racecadotril in Children with Acute Diarrhea. Dhaka Shishu Hosp J. 2020; 36(1): 8-13.

https://doi.org/10.3329/dshj.v36i1.52617

Pienar C, Benninga MA, Broekaert IJ, Dolinsek J, Mas E, Miele E, et al. Drugs in Focus: The Use of Racecadotril in Paediatric Gastrointestinal Disease. J Pediatr Gastroenterol Nutr 2020; 70(2): 162-164.

https://doi.org/10.1097/MPG.0000000000002574

Rautenberg TA, Downes M, Kiet PHT, Ashoush N, Dennis AR, Kim K. Evaluating the cost utility of racecadotril in addition to oral rehydration solution versus oral rehydration solution alone for children with acute watery diarrhea in four low middle-income countries: Egypt, Morocco, Philippines and Vietnam. J Med Econ 2022; 25(1): 274-281.

https://doi.org/10.1080/13696998.2022.2037918

Florez ID, Veroniki AA, Al Khalifah R, Yepes-Nuñez JJ, Sierra JM, Vernooij RWM, et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS One 2018; 13(12): e0207701. https://doi.org/10.1371/journal.pone.0207701

Turck D, Berard H, Fretault N, Lecomte JM. Comparison of racecadotril and loperamide in children with acute diarrhea. Aliment Pharmacol Ther 1999; Suppl 6: 27-302.

https://doi.org/10.1046/j.1365-2036.1999.00004.x-i1

Eberlin M, Chen M, Mueck T, Däbritz J. Racecadotril in the treatment of acute diarrhea in children: a systematic, comprehensive review and meta-analysis of randomized controlled trials. BMC Pediatr 2018; 18(1): 124.

https://doi.org/10.1186/s12887-018-1095-x

Gutiérrez-Castrellón P, Ortíz-Hernández AA, Llamosas-Gallardo B, Acosta-Bastidas MA, Jiménez-Gutiérrez C, Diaz-García L, et al. Efficacy of racecadotril vs. smectite, probiotics or zinc as an integral part of treatment of acute diarrhea in children under five years: A meta-analysis of multiple treatments. Gac Med Mex 2015; 151(3): 329-337.

Coffin B, Hamza H, Vetel JM, Lehert P. Racecadotril in the treatment of acute diarrhea in adults. An individual patient data based meta-analysis. Int J Clin Med 2014; 5(7): 345.

https://doi.org/10.4236/ ijcm.2014.57051

Alam NH, Ashraf H, Khan WA, Karim MM, Fuchs GJ. Efficacy and tolerability of racecadotril in the treatment of cholera in adults: a double blind, randomised, controlled clinical trial. Gut 2003; 52(10): 1419-1423. https://doi.org/10.1136/gut.52.10.1419

Cézard JP, Duhamel JF, Meyer M, Pharaon I, Bellaiche M, Maurage C, et al. Efficacy and tolerability of racecadotril in acute diarrhea in children. Gastroenterology 2001; 120(4): 799-805.

https://doi.org/10.1053/gast.2001.22544

Rautenberg TA, Zerwes U, Foerster D, Aultman R. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model. Clinicoecon Outcomes Res 2012; 4: 109-116. https://doi.org/10.2147/CEOR.S31238

Gordon M, Akobeng A. Racecadotril for acute diarrhea in children: systematic review and meta-analyses. Arch Dis Child 2016; 101(3): 234-240.

https://doi.org/10.1136/archdischild-2015-309676

Lehert P, Chéron G, Calatayud GA, Cézard JP, Castrellón PG, Garcia JM, et al. Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis 2011; 43(9): 707-713. https://doi.org/10.1016/j.dld.2011.03.001

Kang G, Thuppal SV, Srinivasan R, Sarkar R, Subashini B, Venugopal S, et al. Racecadotril in the Management of Rotavirus and Non-rotavirus Diarrhea in Under-five Children: Two Randomized, Double-blind, Placebo-controlled Trials. Indian Pediatr 2016; 53(7): 595-600.

https://doi.org/10.1007/s13312-016-0894-0

Sreenivas SK, Lakshmi M, Pavitra NA. Efficacy and safety of racecadotril as an adjunct to oral rehydration therapy for acute watery diarrhea in children. Ind J Child Health 2017; 4(1): 68-71. https://doi.org/10.32677/IJCH.2017.v04.i01.018