FPIN's Help Desk Answers
Antiemetics for Acute Gastroenteritis in Children
Am Fam Physician. 2020 Jul 1;102(1):51-52.
What is the best antiemetic for vomiting in children with acute gastroenteritis?
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.)
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,
Referencesshow all references
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.
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