Antiemetics for Acute Gastroenteritis in Children

Pnina Strasbourger; Gary Kelsberg; Sarah Safranek

Jul 1, 2020 Issue

FPIN's Help Desk Answers

Antiemetics for Acute Gastroenteritis in Children

PNINA STRASBOURGER, MD, and GARY KELSBERG, MD, University of Washington Valley Family Medicine Residency, Renton, Washington

SARAH SAFRANEK, MLIS, University of Washington Health Sciences Library, Seattle, Washington

Am Fam Physician. 2020 Jul 1;102(1):51-52.

Clinical Question

What is the best antiemetic for vomiting in children with acute gastroenteritis?

Evidence-Based Answer

Oral ondansetron (Zofran) may be given to children presenting to the emergency department with vomiting and mild to moderate dehydration from acute gastroenteritis. It reduces hospital admissions and the need for intravenous hydration. (Strength of Recommendation: A, based on a meta-analysis of moderate-quality randomized controlled trials [RCTs] and a subsequent RCT.)

Evidence Summary

Two systematic reviews1,2 and an RCT3 evaluating oral ondansetron in children with vomiting from acute gastroenteritis in the emergency department setting found that it improved multiple outcomes. Children diagnosed with mild to moderate dehydration (n = 465) received ondansetron at varying dosages based on weight. Ondansetron reduced hospital admissions (relative risk [RR] = 0.4; 95% CI, 0.19 to 0.87) and the need for intravenous hydration (RR = 0.41; 95% CI, 0.29 to 0.59), and it decreased the failure rate of oral hydration. Those who received ondansetron were more likely to stop vomiting (RR = 1.33; 95% CI, 1.19 to 1.49) but were not less likely to return for further care. The studies were rated as moderate quality. Three studies included in one of the systematic reviews1 reported significantly increased diarrhea in children taking ondansetron (P < .05), but they did not quantify the difference between the treatment and placebo groups. A subsequent RCT (N = 176) found that ondansetron use led to significantly fewer failures of oral rehydration (12 of 82 children receiving ondansetron vs. 24 of 83 children receiving placebo; P = .04).3

A systematic review of RCTs comparing antiemetics with placebo in children presenting to the emergency department with acute gastroenteritis found some benefit from dimenhydrinate rectal suppositories and oral granisetron (Kytril).4 One of the RCTs (n = 208) found that dimenhydrinate slightly reduced days of continued vomiting (0.34 fewer days; 95% CI,

Address correspondence to Gary Kelsberg, MD, at gary_kelsberg@valleymed.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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1. Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. 2011;(9):CD005506....

2. Tomasik E, Ziólkowska E, Kolodziej M, et al. Systematic review with meta-analysis: ondansetron for vomiting in children with acute gastroenteritis. Aliment Pharmacol Ther. 2016;44(5):438–446.

3. Golshekan K, Badeli H, Rezaieian S, et al. Effect of oral ondansetron on decreasing the vomiting associated with acute gastroenteritis in Iranian children. Iran J Pediatr. 2013;23(5):557–563.

4. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open. 2012;2(4):e000622.

5. Gheini S, Ameli S, Hoseini J. Effect of oral dimenhydrinate in children with acute gastroenteritis. Oman Med J. 2016;31(1):18–21.

6. Marchetti F, Bonati M, Maestro A, et al.; SONDO Investigators. Oral ondansetron versus domperidone for acute gastroenteritis in pediatric emergency departments. PLoS One. 2016;11(11):e0165441.

7. Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Paediatric Gastroenterology Hepatology and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr. 2014;59(1):132–152.

8. Guarino A, Lo Vecchio A, Dias JA, et al. Universal recommendations for the management of acute diarrhea in non-malnourished children. J Pediatr Gastroenterol Nutr. 2018;67(5):586–593.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

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