Written by Sam Parnell
Ondansetron appears to be the most effective antiemetic for cessation of vomiting, reducing risk of hospitalization, and decreasing need for IV hydration for children with acute gastroenteritis.
Why does this matter?
Acute gastroenteritis is a common disease encountered in the pediatric acute care setting. Dehydration is a primary concern, especially when patients are unable to tolerate oral rehydration therapy due to vomiting. A variety of antiemetics have been used for children with acute gastroenteritis, but the evidence on the efficacy and safety of these therapies is limited.
Can ondansetron end the emesis?
This was a meta-analysis of 24 studies with a total of 3,482 children diagnosed with acute diarrhea and gastroenteritis. The reviewers determined with high certainty that ondansetron was the only antiemetic categorized as the “best intervention” (i.e. the only intervention better than placebo and better than at least one of the other interventions) for cessation of vomiting, hospitalization prevention, and the need for IV rehydration. Other antiemetics including metoclopramide, domperidone, dexamethasone, dimenhydrinate, and granisetron were less effective than ondansetron and similar to placebo. Ondansetron was considered to have minimal serious adverse events and the risk of diarrhea was no higher than placebo.
Of note, a subgroup analysis suggested that the effectiveness of ondansetron was improved with oral administration compared to intravenous administration. and that its effectiveness was lower when vomiting was severe.
This study has several limitations, and the evidence in many treatment comparisons was of low quality. However, based on this study, oral ondansetron may be a safe and effective therapy for children with acute gastroenteritis at risk for failure of oral rehydration and can possibly prevent need for IV rehydration and subsequent hospitalization.
Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis. Pediatrics. 2020 Mar 4. pii: e20193260. doi: 10.1542/peds.2019-3260. [Epub ahead of print]
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