title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Children with acute diarrhoea, as defined by the primary studies.
  
  
  METHODS
  RCTs comparing racecadotril with placebo or other interventions.
  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/kaolin 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 and loperamide. A meta-analysis of three studies with 642 participants showed significantly shorter duration of symptoms with racecadotril compared with placebo (mean difference -53.48 h, 95% CI -65.64 to -41.33). A meta-analysis of five studies with 949 participants showed no significant difference in adverse events between racecadotril and placebo (risk ratio 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 to be safe and well tolerated.
authors.affiliation: Department of Medical Education, Blackpool Victoria Hospital, Blackpool, UK School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.
authors.forename: Morris
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Sidra Medical & Research Center, Doha, Qatar Royal Manchester Children's Hospital, Manchester Academic Health Centre, University of Manchester, Manchester, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Akobeng
mesh_terms: D000208:Acute Disease; D000930:Antidiarrheals / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003967:Diarrhea / Q000188:drug therapy*; D006801:Humans; D015244:Thiorphan / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; C049331:racecadotril; D015244:Thiorphan
keywords: Evidence Based Medicine; Gastroenterology; General Paediatrics