Antisecretory Medication Versus Probiotics in Children Less Than 2 Years Presenting with Acute Watery Diarrhea

Background: Acute watery diarrhea remains a leading cause of morbidity and mortality in children under two years of age. While oral rehydration therapy is standard, adjunctive treatments such as antisecretory agents and probiotics are frequently used to reduce stool volume and disease duration. Objective: To compare the effectiveness of Racecadotril (an antisecretory agent) versus probiotics in reducing the duration of diarrhea, stool frequency, and dehydration in children under two years of age with acute watery diarrhea. Methods: This randomized controlled trial was conducted at the Department of Pediatrics, Hameed Latif Hospital, Lahore from 2nd Sep 2024 to 2nd March 2025. Sixty children under two years presenting with acute watery diarrhea were enrolled and randomly assigned into two groups (n = 30 each). Group A received Racecadotril along with standard therapy (ORS and zinc), while Group B received probiotics (smectite, Lactobacillus GG, L. reuteri, S. boulardii) with standard therapy. Results: The mean duration of diarrhea was significantly shorter in the Racecadotril group (16.4 ± 2.1 hours) compared to the Probiotic group (25.8 ± 3.9 hours; p < 0.001). Mean stool frequency on Day 3 was also lower in Group A (3.1 ± 1.0) than in Group B (5.4 ± 1.5; p < 0.001). Dehydration occurred in 10% of children in the Racecadotril group versus 30% in the Probiotic group (p = 0.04). Hospital admissions were fewer in Group A (6.7%) than in Group B (20%), although this difference was not statistically significant (p = 0.12). Conclusion: It is concluded that Racecadotril is more effective than probiotics in reducing diarrhea duration, stool frequency, and dehydration in children under two years. Given its rapid therapeutic action and favorable safety profile, Racecadotril should be considered a valuable adjunct to standard diarrhea management in this population.