Acute infectious diarrhea (AID) represents an important clinical entity both regarding morbidity and mortality rates, even in industrialized countries, and it leads to one of the major public health burdens, among gastroenterological diseases, with significant healthcare costs. Oral rehydration solution is the cornerstone of the therapy, but despite its proven efficacy in avoiding dehydration, it is still underused as it does not reduce the duration of diarrhea; hence, it is perceived as ineffective by caregivers. In this narrative review, we collected literature regarding the use of racecadotril, deeply discussing its role in the treatment of AID in both adults and children. Racecadotril has been studied in wide populations of patients, in many countries, and in different clinical settings. Its effectiveness in reducing the stool output and the duration of diarrhea has been proven, not only in the early phase of the disease. Racecadotril has been shown to increase the likelihood of home management of AID, to reduce hospitalizations and parenteral rehydration needs resulting in healthcare costs reduction. The current new formulations require only two-daily doses for adults and the pediatric syrup should simplify its use.
Keywords: adults; children; diarrhea; racecadotril.
Racecadotril an effective anti-diarrheal drug Acute diarrhea is one of more frequent infectious diseases, with risk of dehydration if not adequately treated especially in children and the elderly, and this impacts on the healthcare costs beyond on the caregivers. Racecadotril, the first and only intestinal antisecretory drug, acting on the abnormal intestinal hypersecretion, decreases the loss of water and electrolytes from the gut, so reducing the dehydration risk, it increases the likelihood of home management of diarrhea. The efficacy of racecadotril has been demonstrated in all settings (inpatients, outpatients, and community-based), in patients of all ages (children, adults, and the elderly), in many countries both of high-income and low-middle-income. In addition, the safety of racecadotril has always been comparable to placebo and better than loperamide.
© The Author(s), 2025.