Context

Treatment alternatives

The NICE clinical guideline on diarrhoea and vomiting in children under 5 recommends low-osmolarity oral rehydration salt (ORS) solution for children with dehydration and those at risk of dehydration. Antidiarrhoeal drugs are not recommended by the guideline (although it should be noted that racecadotril was not available in the UK when the guideline was published in 2009). Some antimotility agents such as loperamide syrup and co-phenotrope tablets are licensed in children aged 4 years and over, but the BNF for children advises that they are not recommended for use in children under 12 years.

Costs of treatment alternatives

Drug

Age or weight of child

Usual dosage a

7-day cost excluding VAT b

Racecadotril sachetsc

Less than 9 kg (3 months to 1 year)d

1x10 mg 3 times daily

£8.42e

9 to less than 13 kg (about 1 to 3 years)d

2x10 mg 3 times daily

£16.84e

13 to 27 kg (about 3 to 10 years)d

1x30 mg 3 times daily

£8.42e

More than 27 kg (about 8 years and over)d

2x30 mg 3 times daily

£16.84e

Codeine phosphatef,g

12 years and over

30 mg 3 to 4 times daily

Oral solution 25 mg/5 ml £1.33 to £1.78h

30 mg tablets £1.12 to £1.49h

Co-phenotrope 2.5/0.025 mg tabletsf,g

12 years

1 tablet 4 times daily

£3.01h

13 to 16 years

2 tablets 3 times daily

£4.51h

Loperamidef,g

12 to 18 years

Usual dose 6 to 8 mg daily

Oral solution 1 mg/5 ml £2.46 to £3.28h

2 mg capsules £0.66 to £0.88h

2 mg tablets £1.51 to £2.01h

2 mg orodispersible tablets £5.86 to £7.81h

aThe doses shown do not all represent the full range that can be used and they do not imply therapeutic equivalence.

bThese costs will be additional to the cost of oral rehydration salt (ORS) solution because antidiarrhoeal drugs should generally be used as adjunctive therapy.

c Doses taken from the Hidrasec summaries of product characteristics for infants and children.

dApproximate values for age by weight taken from the BNF for children.

e Costs are for 20 doses (standard pack size) and are taken from MIMS February 2013.

f Doses taken from the BNF for children.

gCosts are not given for younger children when drugs are not licensed or not recommended in the BNF for children.

h Costs taken from Drug Tariff February 2013.

In children, racecadotril (and other antidiarrhoeal medication if appropriate) should be used with ORS solution. Therefore, ORS solution is not a treatment alternative and the cost is not given in this evidence summary.