Racecadotril versus loperamide: antidiarrheal research revisited

Racecadotril is an enkephalinase inhibitor, presented as a purely antisecretory agent with advantages over the opiate-receptor agonist loperamide in the treatment of diarrhea. A critical review of the literature and the models used was performed. Although pretreatment with high doses of racecadotril reduced cholera toxin-induced secretion and although clinical efficacy was demonstrated in young infants—a population characterized by 10-fold higher plasma enkephalin concentrations compared with adults, the analysis calls into question the peripheral antisecretory selectivity and relative clinical efficacy. Conversely, loperamide can be proposed as an antisecretory agent at therapeutic concentrations. Its efficacy is well established in acute and chronic diarrhea. Current experimental and clinical comparative studies of both drugs have problems with regard to the selection of the doses, the validity of models, and/or the trial design. The conclusion is that more research is needed before reliable conclusions can be drawn on the place of racecadotril in diarrhea treatment.     

蒙脱石散联合双歧杆菌四联活菌片、消旋卡多曲治疗小儿急性腹泻的临床效果

目的探究蒙脱石散联合双歧杆菌四联活菌片、消旋卡多曲治疗小儿急性腹泻的临床效果。方法将我院收治的68例急性腹泻患儿根据治疗药物不同分为对照组(34例,蒙脱石散联合双歧杆菌四联活菌片)和观察组(34例,在对照组基础上加用消旋卡多曲)。比较两组的临床治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的LDH、CK、CK-MB水平及CD8+均降低,CD4^+、CD4^+/CD8^+均升高,且观察组优于对照组(P<0.05)。结论蒙脱石散、双歧杆菌四联活菌片及消旋卡多曲联合治疗小儿急性腹泻能够有效提高患儿的治疗效果,增强其免疫力,避免了疾病对患儿心肌的损害,效果显著。     

消旋卡多曲治疗成人急性腹泻的临床疗效

目的观察消旋卡多曲(抗腹泻药)治疗成人急性腹泻的临床疗效及安全性。方法将109例急性腹泻患者随机分为消旋卡多曲治疗组(55例)和对照组(54例)。对照组用WHO标准化口服补液治疗,纠正电解质和酸碱失衡;治疗组在此基础上,加用消旋卡多曲每次100 mg,每天3次。观察2组临床疗效及不良反应发生情况。结果治疗组大便次数及性质恢复时间较对照组缩短,分别为(33.3±23.96)h vs(64.3±27.32)h;(47.8±10.46)h vs(70.8±12.82)h;脱水、电解质紊乱纠正时间也较对照组明显缩短,分别为(30.7±14.51)h vs(56.0±16.58)h;消旋卡多曲治疗总病程短于对照组,分别为(56.8±20.51)hvs(90.9±21.35)h;治疗72 h后,治疗组总有效率(90.90%)高于对照组(72.22%),差异有统计学意义(P<0.05)。结论常规治疗基础上配合消旋卡多曲治疗,可较快缓解急性腹泻的病情,缩短病程,且安全。     

脑啡肽酶抑制剂消旋卡多曲的药理及临床评价

消旋卡多曲是一种脑啡肽酶的抑制剂，临床主要用于治疗成人急性腹泻及1月以上婴儿和儿童的腹泻。现对其药理作用、药动学及临床评价进行综述。     

消旋卡多曲联合腹泻宁颗粒治疗小儿轮状病毒性肠炎66例

目的:观察消旋卡多曲联合腹泻宁治疗小儿轮状病毒性肠炎的临床疗效。方法:选取诊断为小儿轮状病毒性肠炎患儿126例,随机分为对照组60例和治疗组66例。对照组给予思密达,治疗组采用消旋卡多曲颗粒联合腹泻宁颗粒。观察两组患儿的临床疗效及大便性状恢复时间、大便次数恢复时间和腹泻总疗程。结果:治疗组有效率为96.96%,对照组有效率为81.67%,两组有效率比较,差异具有统计学意义(P0.05)。对照组大便性状恢复时间为(4.33±0.61)d,大便次数恢复时间为(5.13±0.60)d,治疗组分别为(3.03±0.77)d、(4.54±0.75)d,两组比较,差异均有统计学意义(P0.05)。结论:消旋卡多曲联合腹泻宁颗粒治疗小儿轮状病毒性肠炎有显著作用,能有效减轻临床症状,缩短病程,提高治愈率。     

消旋卡多曲治疗婴幼儿急性水样便腹泻的效果

目的观察消旋卡多曲治疗婴幼儿急性水样便腹泻的效果。方法将278例病儿随机分为2组，对照组口服思密达、妈咪爱，治疗组在对照组的基础上口服消旋卡多曲，观察72h，判断疗效。结果治疗组总有效率高于对照组，差异有显著性（Χ^2=10．28，P〈0．01）。结论消旋卡多曲治疗婴幼儿急性水样便腹泻有效。     

反相高效液相色谱法测定消旋卡多曲干混悬剂中消旋卡多曲含量

目的建立高效液相色谱法测定消旋卡多曲干混悬剂中消旋卡多曲含量的方法。方法色谱柱为C18柱，流动相为乙腈-磷酸二氢钾溶液（70：30,v／v），检测波长为210hm。结果消旋卡多曲在5．68～28．40μg／mL浓度范围内与峰面积有良好的线性关系，日内RSD≤1．00％，日间RSD≤1.41％，平均回收率为100．03％。结论本法专属性强，结果准确。     

HPLC测定消旋卡多曲的含量及杂质

 目的建立新的高效液相法测定消旋卡多曲的含量及其杂质。方法采用C₁₈色谱柱(4.60cm×25 cm),以乙腈磷酸二氢钾溶液(取磷酸二氢钾1g,加85%磷酸1mL,加水稀释至1000 mL)(70∶30)为流动相;检测波长为210 nm。结果含量线性范围为0.08～0.24 mg·mL^-1,回归方程为Y=15847X+3873(r=0.9997),已知杂质benzylthiorphan disulphide线性范围为2.40～21.6μg·mL^-1,回归方程为Y=1826X+46(r=0.9999),其最低检测浓度为1μg·mL^-1,加样平均回收率为100.0%(n=6)。结论方法简便、快速准确。     

Acute infectious pediatric gastroenteritis: beyond oral rehydration therapy

Worldwide diarrheal diseases are a leading cause of childhood morbidity and mortality. Improvements in gastroenteritis management have reduced the annual number of pediatric deaths attributable to gastroenteritis from 5 million in 1982 to 2 million over 20 years. Recent advances are likely to contribute further to a reduction in morbidity and mortality secondary to acute infectious gastroenteritis. A new generation of vaccines against rotavirus is entering into routine use. Research into antisecretory agents has demonstrated that this class of medications may play a significant role in the future management of acute infectious gastroenteritis. A significant body of literature has recently emerged supporting the use of the antiemetic agent ondansetron. In developing countries, the routine use of zinc is now recommended by many experts, while, in developed countries, the use of probiotic agents has been associated with significant benefits in acute infectious gastroenteritis. Finally, more aggressive intravenous rehydration strategies are being employed; however, at present, limited data from randomized clinical trials are available to support its routine use.