BACKGROUND: Diarrhea is a common and disabling symptom seen in patients with Human Immunodeficiency Virus (HIV) infection and the Acquired Immune Deficiency Syndrome (AIDS). The diarrhea is chronic and results in malabsorption contributing to cachexia. Symptomatic treatment can improve the quality of life and nutritional status of these patients.

The endogenous group of opiates known as enkephalins function as anti-secretory agents without affecting intestinal transit. Racecadotril (acetorphan) is an orally active enkephalinase inhibitor. Available studies have focused on the use of racecadotril in healthy adults and children with acute infectious diarrhea.

OBJECTIVES:To assess the efficacy of racecadotril (acetorphan) in reducing the duration and frequency of bowel movement in adult HIV patients with chronic diarrhea.

METHODS:  Electronic databases were searched for randomized controlled trials which used racecadotril for chronic diarrhea in HIV patients. Three independent reviewers assessed the quality of the two studies based on the Cochrane Infectious Disease Group prior to inclusion in study. Data extracted were analyzed using Revman Version 5. Test for heterogeneity was performed using the chi square test.

RESULTS: Results showed the standardized mean difference for the two trials comparing racecadotril to placebo and octreotide in reducing bowel movements from baseline was -1.00 (95% CI -1.16 to -0.84, Z=12.08, p<0.00001), showing a beneficial effect. Response rate for the two trials comparing racecadotril to placebo or octreotide in reducing bowel movements from baseline was -0.13 (95% CI -0.26 to 0.01, Z=1.84, p<0.07), showing a trend towards benefit in terms of response rates. Heterogeneity was statistically insignificant (p=1, I2=0%).

CONCLUSIONS: There is evidence pointing to a benefit in using racecadotril in HIV and AIDS-associated, non-infectious diarrhea by decreasing the frequency of loose stools. An individualized approach is still recommended in its use for HIV patients with chronic diarrhea.

Human ; Racecadotril ; Hiv ; Diarrhea

Diarrhea has been the subject of considerable attention and effort. A variety of anti-secretory agents have been subjected to countless investigations including racecadotril as an adjunct therapy. Objectives: To assess the effectiveness of racecadotril, along with oral rehydration solution, in the treatment of diarrhea. Methods: The Cochrane Library and Pubmed were searched for trials; high sensitive search terms were used including "randomized controlled trials", "racecadotril" and "diarrhea". Outcome measures were stool output, duration of diarrhea, and number of bowel movements. Data Collection and Analysis: Three reviewers assessed the methodological quality. Analysis was implemented with Review Manager 5 using standard mean difference as treatment measure. Results: The search yielded 21 results; four of which fulfilled selection criteria. A total of 659 participants were given 1.5mg/kg of racecadotril. The meta-analysis showed that racecadotril is effective in reducing stool output in 48 hours compared to the control group. This finding was congruent for those positive for rotavirus and for the duration of the diarrhea. There were lesser children who revisited their doctors after 48 hours of treatment. The chance of cure after day seven of treatment was higher in the racecadotril group when compared to the control group. Racecadotril with ORS was comparable to ORS alone in terms of safety and tolerability. Conclusion: There is evidence that the drug racecadotril holds promise in terms of reducing stool output, number of bowel movements and duration of diarrhea. However, well-designed randomized control trails with an adequate sample size and absence of any competitive interest in studying the efficacy and safety of racecadotril in acute diarrhea are needed before we reach any conclusion regarding the role of the drug in diarrhea.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; DIARRHEA ; RACECADOTRIL