EFFECTS OF RACECADOTRIL ON THE TREATMENT OF ACUTE WATERY DIARRHEA IN CHILDREN

Abstract

Background: Acute watery diarrhea remains a leading cause of childhood morbidity in Pakistan. Racecadotril, an enkephalinase inhibitor with antisecretory properties, has shown variable efficacy in pediatric populations. This study compared the efficacy of Racecadotril plus oral rehydration solution (ORS) versus ORS alone in children with acute watery diarrhea. Methods: A quasi-experimental study was conducted at the Department of Pediatrics, Combined Military Hospital, Quetta, from July to December 2025. A total of 220 children aged 1 to 12 years with acute watery diarrhea were admitted using non-probability consecutive sampling. Participants were allocated to Group A (Racecadotril 1.5 mg/kg/day thrice daily plus ORS, n=110) and Group B (ORS alone, n=110) based on odd/even medical registration number. The primary outcome was diarrhea resolution at 72 hours, defined as <3 stools per day with Bristol Stool-Scale type 4 or 5. Baseline characteristics and stool pathogens were also analyzed. Chi-square test was used for comparison, with p ≤ 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Median age was 3.2 years (IQR: 1.8-5.5) in Group A and 3.4 years (IQR: 1.9-5.6) in Group B (p = 0.76). Rotavirus A was the predominant pathogen, detected in 107 (48.6%) children. At 72 hours, diarrhea resolution was achieved in 88 (80.0%) children in Group A compared to 70 (63.6%) in Group B (χ² = 7.43, p = 0.008), representing a 16.4 percentage point absolute difference. The treatment effect was most pronounced in children aged 1-3 years (82.1% vs. 57.4%; p = 0.005). No significant differences were observed in older age subgroups. Conclusion: Racecadotril to ORS significantly improves diarrhea resolution at 72 hours in children aged 1 to 12 years with acute watery diarrhea, with greatest benefit in children under four years. Racecadotril is an effective adjunctive therapy to ORS in Pakistani clinical settings.