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• Antidiarrheal agents — We suggest that antidiarrheal agents not be routinely administered in the treatment of acute viral gastroenteritis. High-quality evidence of efficacy is lacking for most antidiarrheal agents and there is a potential for serious side effects. ●Antimotility drugs – Opiate receptor agonists, such as loperamide and diphenoxylate-atropine combinations, reduce intestinal motility. These drugs have potentially severe side effects, including lethargy, paralytic ileus, toxic megacolon, central nervous system depression, coma, and even death in less than 1 percent. In addition, because they delay transit time, they can prolong the course of bacterial diarrheas, such as that caused by Shigella and Escherichia coli. Whether this also is true in viral gastroenteritis is unknown. ●Antisecretory drugs – Antisecretory drugs include bismuth subsalicylate and racecadotril (acetorphan). • •Bismuth subsalicylate requires frequent dosing with limited efficacy and has potential toxicity from salicylate absorption. It should not be routinely used in the management of children with gastroenteritis. • •Racecadotril is an enkephalinase inhibitor with antisecretory actions. Whether it is beneficial in the management of acute viral gastroenteritis in children is uncertain. Although racecadotril appears to be safe, meta-analyses of randomized and quasi-randomized trials have inconsistent findings related to benefit, which may be related to inclusion of different trials [. The ove

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