Written by Joshua Belfer
Spoon Feed
Giving kids ondansetron to take home after an ED visit for vomiting due to gastroenteritis significantly reduced the risk of developing moderate-to-severe disease.
We know it helps in the ED––turns out, it helps at home too.
Gastroenteritis is one of the most common pediatric ED presentations, and ondansetron is widely used to manage vomiting. While its benefit in the ED is well established, the value of sending children home with a prescription has been unclear, with prior data mixed and largely observational.
In this multicenter, double-blind, randomized superiority trial, 1,030 children with vomiting and a diagnosis of acute gastroenteritis were randomized to receive either ondansetron or placebo at discharge from the ED. Caregivers were instructed to give up to six doses over 48 hours as needed for ongoing vomiting. The primary outcome was moderate-to-severe gastroenteritis during the 7-day follow-up, defined by a score ≥9 on the modified Vesikari scale. Only 5.1% of children in the ondansetron group reached that threshold versus 12.5% in the placebo group. Ondansetron also reduced the number of vomiting episodes within 48 hours (adjusted rate ratio 0.76), but did not significantly change ED/clinic return visits or IV rehydration rate. Adverse events were similar between groups, although children who received ≥3 doses had slightly more diarrhea.
As a high-quality RCT, the study was well-designed, but it excluded children with underlying medical conditions or recent antiemetic use, which may limit generalizability. Additionally, caregiver-reported outcomes, like vomiting episodes and adherence to dosing, may introduce recall bias or reporting inaccuracies.
How will this change my practice?
A short course of ondansetron at home can reduce progression to more severe illness. With no significant difference in adverse events between groups, I’ll feel confident sending families home with a few extra doses to use as needed after discharge.
Source
Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025 Jul 17;393(3):255-266. doi: 10.1056/NEJMoa2503596. PMID: 40673584.
