Impact of Increasing Ondansetron Use on Clinical Outcomes in Children With Gastroenteritis

Freedman, Stephen B.; Hall, Matt; Shah, Samir S.; Kharbanda, Anupam B.; Aronson, Paul L.; Florin, Todd A.; Mistry, Rakesh D.; Macias, Charles G.; Neuman, Mark I.

doi:10.1001/jamapediatrics.2013.4906

Cited by 47 publications

(46 citation statements)

References 25 publications

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“…Further studies are needed to understand if, in the real context of ED care, the use of ondansetron in children at high risk of dehydration can effectively reduce the number of cases receiving IVT. Indeed, despite the increasing use of ondansetron over the years in the United States and Canada, the percentage of children requiring IVT doesn’t seem to have decreased [38]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…55 In a recent study, even though the frequency of use of ondansetron drastically increased, the rate of IV rehydration or hospitalization did not change. 56 Well-designed studies are still needed to elucidate the clinical situations when a benefit would confer and to further investigate any safety concerns.…”

Section: Discussionmentioning

confidence: 99%

Fatal Cardiac Arrest in 2 Children

Brenner¹,

Boucher²

2016

Pediatr Emer Care

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“…It has been estimated that this database captures approximately 15% of all pediatric admissions across the country. 4–6 …”

Section: Methodsmentioning

confidence: 99%

Indoor tobacco legislation is associated with fewer emergency department visits for asthma exacerbation in children

Ciaccio

Gurley-Calvez

Shireman

2016

Annals of Allergy, Asthma & Immunology

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Impact of Increasing Ondansetron Use on Clinical Outcomes in Children With Gastroenteritis

Cited by 47 publications

References 25 publications

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

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

Fatal Cardiac Arrest in 2 Children

Indoor tobacco legislation is associated with fewer emergency department visits for asthma exacerbation in children

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