Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework

Abstract

ObjectiveTo assess the evidence for the safety and effectiveness of antiemetics on gastroenteritis-induced vomiting in children and adolescents.DesignSystematic review.Data SourcesThe Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE searched from 1980 to March 2012.MethodsMethods included comprehensive searches, data synthesis, meta-analysis and mixed treatment comparisons (MTC).Review methodsReference lists were checked, and missing or inconsistent data were sought from trial investigators. Randomised controlled trials comparing antiemetics in participants younger than 18 years and who were vomiting due to acute gastroenteritis. Four meta-analyses and three MTC were carried out.Results10 trials (1479 participants) and five treatments were included: dexamethasone, dimenhydrinate, granisetron, metoclopramide and ondansetron. There was clear evidence that ondansetron (oral or intravenous) compared with placebo increased the proportion of patients with cessation of vomiting (orally administered) (RR 1.44, 95% CI 1.29 to 1.61), reduced the immediate hospital admission rate (orally administered) (RR 0.40, 95% CI 0.19 to 0.83) and the need for intravenous rehydration therapy (orally administered) (RR 0.41, 95% CI 0.29 to 0.59). No significant difference was noted in the revisit rates, but ondansetron was associated with an increase in episodes of diarrhoea. There was no evidence for the use of dexamethasone or metoclopramide and limited evidence that dimenhydrinate or granisetron increased the cessation of vomiting. The MTC analysis suggested that ondansetron was the most likely treatment to stop the child vomiting. Nine studies were carried out in secondary care and one in primary care.ConclusionsThis systematic review used a method novel to this clinical area and found clear evidence that ondansetron was the most likely treatment to allow oral rehydration therapy to commence. Given the significance of these results, the authors urge healthcare policy makers to consider the wider use of ondansetron in secondary care. Furthermore, randomised controlled trials are needed to investigate the effectiveness of antiemetic treatment in primary care (including ambulatory care interventions).

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

“…This means that, in an ED setting, 6 out of 10 children aged 1–6 years with vomiting due to AGE and no or mild to moderate dehydration, can be successfully treated with oral rehydration solution alone, without the need for drugs. This finding is consistent with the estimates of the Cochrane review [17, 18]. …”

“…Hospital admission rates are lower in the ondansetron group vs both domperidone and placebo. Differences among groups did not reach the statistical significance of the meta-analysis (RR 0.41; 95% IC 0.29 to 0.59) [18]. In the present study, the need for observation stay to last more than six hours is statistically significantly lower in the ondansetron group compared with the domperidone and placebo groups.…”

“…Evidence exists that ondansetron compared with placebo increases the proportion of patients with cessation of vomiting, reduces the immediate hospital admission rate and the need for IVT. However, not all of these studies evaluate first-line oral rehydration therapy (ORT) during hospital stay before the administration of the antiemetic [18], and an adequate comparative evaluation between domperidone and ondansetron is missing [4, 20]. Concerning the use of domperidone, only few studies are available with small sample sizes, low methodological quality, and inconsistent results [4, 15, 17, 18–23].…”

Effectiveness of granisetron in controlling pediatric gastroenteritis–related vomiting after discharge from the ED

“…The return visits to ED were comparable between the study groups at the 24-hour follow-up. This trial [6] has been considered to have reported incoherent data with inflated treatment effect [14]. Pediatric viral GE is a self-limited disease [15].…”

Emergency Department Ondansetron Use in Children with Type 1 Diabetes Mellitus and Vomiting

“…[8][9][10][11] Ondansetron, an antiemetic agent that is increasingly employed in the ED to prevent emesis, 12,13 is now routinely administered to children with vomiting because of acute gastroenteritis, a common intercurrent illness in children. [8][9][10][11][14][15][16] In Europe, gastroenteritis is estimated to cause 14.1% of pediatric diabetic ketoacidosis (DKA). 17 Because ondansetron is nonsedating and is anecdotally increasingly used in children with T1DM, we sought to determine if its administration to children with T1DM presenting for ED care with vomiting because of intercurrent illness is associated with improved clinical outcomes.…”