Racecadotril for acute diarrhoea in children: systematic review and meta-analyses

Abstract

OBJECTIVE
Racecadotril is an antisecretory agent that can prevent fluid/electrolyte depletion from the bowel as a result of acute diarrhoea, without affecting intestinal motility. An up-to-date systematic review is indicated to summarise the evidence on Racecadotril for the treatment of acute diarrhoea in children.
DESIGN
A Cochrane format systematic review of Randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool.
PATIENTS
Children with acute diarrhoea, as defined by the primary studies.
INTERVENTIONS
RCTs comparing racecadotril to placebo or other interventions.
MAIN OUTCOME MEASURS
Duration of illness, stool output/volume and adverse events.
RESULTS
Seven RCTs were included. Five comparing racecadotril with placebo or no intervention, one with pectin / caolin and one with loperamide. Moderate to high risk of bias was present in all studies. There was no significant difference in efficacy or adverse events between racecadotril to loperamide. Meta-analysis of 3 studies with 642 participants showed significantly shorter duration of symptoms with racecadotril compared to placebo (Mean Difference (MD) -53.48 hours, 95% CI -65.64 to -41.33,). Meta-analysis of 5 studies with 949 participants showed no significant difference in adverse events between racecadotril and placebo (Risk Ratio (RR) 0.99, 95% CI 0.73 to 1.34).

CONCLUSIONS
There is some evidence that racecadotril is more effective than placebo or no intervention in reducing the duration of illness and stool output in children with acute diarrhoea. However, the overall quality of the evidence is limited due to sparse data, heterogeneity and risk of bias. Racecadotril appears safe and well tolerated