Acute diarrhoea in infants and even adults is a health concern and left untreated may lead to serious health risks. - AFP
New drug for the treatment of acute diarrhoea in infants as young as three months of age is now available.
Racecadotril is an anti-secretory agent approved for complementary symptomatic treatment of acute diarrhoea in infants and children, and for use as symptomatic treatment in adults.
It is recommended as an adjunctive therapy to oral re-hydration therapy in the 2011 Malaysian Clinical Practice Guidelines on the management of acute diarrhoea in children. The drug was recently launched in Malaysia.
For infants and children, it is administered together with oral rehydration therapy (ORT) such as glucose and electrolyte solutions and the usual support measures (i.e. anti-diarrhoeal drugs) when these measures alone are insufficient to control the condition and when causal treatment (treatment directed against the cause of the disease) is not possible.
If causal treatment is possible, the drug can be administered as a complementary treatment.
Consultant paediatrician and paediatric cardiologist Datuk Dr Zulkifli Ismail says, “Diarrhoea describes loose, watery stools that occur more frequently than usual. Because diarrhoea causes such a rapid and high loss of fluids, it puts the patient at risk of dehydration.
“This has been recognised as the most important risk for infants and young children.”
According to the World Health Organization, globally, there are 1.7 billion cases of diarrhoeal diseases annually, and it is the second leading cause of death in children under five years of age .
East Asia and Pacific countries have had tremendous success in reducing child mortality over the past 20 years. The total number of under-five deaths decreased from 2.2 million in 1990 to close to 700,000 in 2010.
Pneumonia and diarrhoea accounted for nearly one-third of those deaths, most of which are among the poorest children.
In Malaysia, the incidence of acute diarrhoea was the highest among young adults aged 20 to 29 years, while a local study in 2006 on deaths among children below the age of five revealed that approximately 4.9% of deaths were due to diarrhoea. Nonetheless, the condition is still grossly under-notified and remains a major public health concern.
Diarrhoea is generally caused by virus or bacteria spread through contaminated food or drinking water due to poor hygiene. The infecting bacteria or virus releases toxins that cause the gut to secrete excessive water, otherwise known as hypersecretion.
The volume of the water is such that it cannot be reabsorbed by the colon and the result is watery and frequent stools.
ORT, which requires drinking plenty of fluids, taking a special oral rehydration solution or intravenous administration of fluids or electrolytes, is key in managing acute diarrhoea by preventing dehydration.
However, ORT does not address the other symptoms of acute diarrhoea such as bloating and nausea.
Additionally, available anti-diarrhoeal medicines that reduce the number of times a person needs to go to the toilet are associated with side effects like constipation.
Furthermore, options for treatment of acute diarrhoea in infants and children are limited, as most are indicated for adults.
Racecadotril is fast-acting, taking effect within 30 minutes of the first dose. It also effectively reduces stool output in infants and children by 50%.
In adults, it is better tolerated, with a lower incidence of side effects such as constipation and abdominal pain .
Dr M Hafeezul Suraj A Wilson, medical director of Established Pharmaceuticals, Abbott Malaysia says, “It has a proven efficacy record and is fast-acting. It is also better tolerated.
“It is now approved for use in all ages – infants as young as three months old, children as well as adults – and is a valuable treatment option for diarrhoea.”