ОСТРАЯ ДИАРЕЯ У ВЗРОСЛЫХ: АКТУАЛЬНОСТЬ ПРОБЛЕМЫ И НОВЫЕ ВОЗМОЖНОСТИ ТЕРАПИИ
Ющук Н.Д., Андреев Д.Н., Кучерявый Ю.А.
Заключение
Вышеизложенное позволяет сделать вывод, что рацекадотрил является новым симптоматическим антидиарейным препаратом, оказывающим непосредственное супрессивное влияние на процессы гиперсекреции воды и электролитов в кишечнике, индуцированные патогенным влиянием вирусов и бактериальных токсинов. Эффективность рацекадотрила в лечении ОД у взрослых пациентов была продемонстрирована в ряде рандомизированных контролируемых клинических исследований и в нескольких метаанализах. Терапия данным препаратом характеризовалась четко выраженным превосходством над плацебо в отношении регрессии продолжительности диареи, а также количества и массы неоформленного стула. По сравнению с эталонной терапией (лоперамид) значительных различий по параметрам эффективности не отмечено, однако было установлено, что при приеме рацекадотрила запоры развиваются реже, что важно с учетом патофизиологических механизмов развития ОКИ. По сравнению с пробиотиком Saccharomyces boulardii рацекадотрил показал несколько большую эффективность, но сходную переносимость. Таким образом, внедрение в клиническую практику рацекадотрила в качестве симптоматической терапии с доказанным противодиарейным эффектом и принципиально отличным от других антидиарейных препаратов антисекреторным механизмом действия позволяет диверсифицировать схемы лечения и открывает новые перспективы ведения этой непростой группы пациентов.
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smectite in treating patients of diarrhea-predominant irritable bowel syndrome.
J Gastroenterol Hepatol. 2007; 22 (12): 2266–72.
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smectite (Smecta) and a probiotic preparation in chronic functional
diarrhea. Dig Liver Dis. 2004; 36 (12): 824–8.
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829–35.
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of diarrhea. Int J Antimicrob. Agents. 2000; 14 (1): 75–9.
38. Racecadotril. Abbott scientific brochure (data on file).
39. Fischbach W., Andresen V., Eberlin M., Mueck T., et al. A comprehensive
comparison of the efficacy and tolerability of racecadotril with
other treatments of acute diarrhea in adults. Front Med (Lausanne).
2016; 3: 44.
40. Baumer P., Dorval E.D., Bertrand J., Vetel J.M. et al. Effects of acetorphan,
an enkephalinase inhibitor, on experimental and acute diarrhea.
Gut. 1992; 33: 753–8.
41. Hamza H., Ben K.H., Baumer P., Berard H., et al. Racecadotril
versus placebo in the treatment of acute diarrhea in adults. Aliment Pharmacol
Ther. 1999; 13 (suppl. 6): 15–9.
42. Vetel J.M., Hamza H., Coffin B., Lehert P. Racecadotril efficacy
in the symptomatic treatment of adult acute diarrhoea: a systematic review
and meta-analysis. Int J Clin Med. 2014; 5: 361–75.
43. Coffin B., Hamza H., Vetel J.M., Lehert P. Racecadotril in the treatment
of acute diarrhoea in adults. An individual patient data based metaanalysis.
Int J Clin Med. 2014; 5: 345–60.
44. Roge J., Baumer P., Berard H., Schwartz J.C., et al. The enkephalinase
inhibitor, acetorphan, in acute diarrhoea. A double-blind, controlled
clinical trial versus loperamide. Scand J Gastroenterol. 1993; 28: 352–4.
45. Vetel J.M., Berard H., Fretault N., Lecomte J.M. Comparison
of racecadotril and loperamide in adults with acute diarrhea. Aliment Pharmacol
Ther. 1999; 13 (suppl. 6): 21–6.
46. Prado D. A multinational comparison of racecadotril and loperamide
in the treatment of acute watery diarrhoea in adults. Scand J Gastroenterol.
2002; 37 (6): 656–61.
47. Gallelli L., Colosimo M., Tolotta G.A., et al. Prospective randomized
double-blind trial of racecadotril compared with loperamide in elderly
people with gastroenteritis living in nursing homes. Eur J Clin Pharmacol.
2010; 66: 137–44.
48. Moraes E., Chinzon D., Coleho L.G., Fernandes T.F., et al. A multicentric,
randomised, investigator-blinded, parallel group study to assess
the efficacy, safety and tolerability of racecadotril versus Saccharomyces
boulardii in the treatment of acute diarrhea in adults. Rev Bras Med. 2001;
58 (1–2): 65–74.
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