Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Abstract

BACKGROUND: Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated, it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children. OBJECTIVES: To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, NNT 6, 95% CI 4 to 13) and an increase in the proportion of patients with cessation of vomiting (RR 1.34, NNT 5, 95% CI 3 to 7). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies. In one study the proportion of patients with cessation of vomiting in 24 hours was (58%) with IV ondansetron, (17%) placebo and (33%) in the metoclopramide group (P value = 0.039). AUTHORS' CONCLUSIONS: Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting. COMMENTSBacterial and viral gastroenteritis are common in children and adolescents. Oral rehydration therapy (ORT) is one of the cornerstones for its treatment. Many pediatricians recommend that antiemetics should only be introduced to treat vomiting if this condition is preventing proper implementation of ORT. In Brazil, remarkably few studies have investigated the action of antiemetics, 1,2 particularly in relation to gastroenteritis. This review compared the efficacy of various antiemetic drugs versus placebo or no treatment in cases of acute vomiting due to gastroenteritis among children and adolescents. Seven published studies fulfilling the review inclusion criteria were taken into consideration, with a total of 1020 patients. The authors indicate that these seven studies had an uncertain or high risk of bias, thus prompting the need for caution when extrapolating the results to clinical practice. Among the outcomes studied, the time taken for cessation of vomiting was 34% lower in a study comparing dimenhydrinate suppositories with placebo. Data from three studies comparing or...

Management strategies in the treatment of neonatal and pediatric gastroenteritis

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“…In Cochrane reviews, diarrhea was reported as a side effect in four of the five ondansetron studies. [133][134][135] According to WHO, of the antiemetics available, those with the greatest evidence of efficacy in the prevention of nausea and vomiting (particularly in the treatment of postsurgery nausea and vomiting) were ondansetron and dexamethasone, ondansetron as first-line treatment with the addition of dexamethasone as required. 136…”

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“…En estos pacientes se podrían utilizar otras alternativas terapéuticas como el ondansetrón, que ha sido mejor valorado en casos de gastroenteritis, pues reduce la necesidad de hidratación endovenosa y de hospitalización; ha demostrado ser igualmente efectivo, pero con un mejor perfil de seguridad en pediatría (23).…”

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“…28 Little information is available about dosage in pediatric patients 4 years of age or younger (Prescribing Information, FDA). Use of ondansetron in children with diarrhea is off-label as it is not approved for vomiting due to diarrheal diseases.…”