ABSTRACT. Objective. Relatively little research has examined the role of antiemetic agents in the treatment of acute gastroenteritis. The use of the selective 5-HT 3 receptor antagonists (eg, ondansetron) offers a potentially valuable treatment option. The objective of this study was to evaluate the efficacy of ondansetron for the treatment of vomiting associated with acute gastroenteritis in children.Methods. A randomized, double blind, placebo-controlled trial was conducted in the emergency department of a tertiary-care children's hospital. Eligible patients were 1 month to 22 years old and required intravenous fluids for gastroenteritis. Of 172 patients approached, 107 were enrolled (54 to intravenous ondansetron, 53 to placebo). The mean age was 5.3 years, and 53% of the patients were male. The frequency of vomiting, admission rate, and occurrence of complications were measured.Results. After drug administration, 38 (70%) of the 54 patients in the ondansetron group had complete cessation of vomiting compared with 27 (51%) of the 53 patients in the placebo group. Sixteen (30%) of the 53 patients in the placebo group required admission compared with 14 (26%) of the 54 in the ondansetron group. An analysis of previously untreated patients with a measured serum carbon dioxide >15 mEq/L showed that 11 (23%) of the 47 who received placebo were admitted compared with 3 (7%) of the 43 who received ondansetron. No significant complications were detected.Conclusions. Intravenous ondansetron decreases vomiting in children with gastroenteritis. In addition, ondansetron reduces the need for admission in those who are treated at an initial visit to the emergency department and have a measured serum carbon dioxide >15 mEq/L. The safety and low cost of this therapy suggests that ondansetron can be valuable in treating gastroenteritis in children. Pediatrics 2002;109(4). URL: http://www. pediatrics.org/cgi/content/full/109/4/e62; pediatric, gastroenteritis, vomiting, ondansetron, antiemetic.ABBREVIATIONS. ED, emergency department; CO 2 , carbon dioxide.A pproximately 30 million children in the United States develop acute gastroenteritis every year. Of these, 3 million seek evaluation by physicians, and a large number of these patients are treated in emergency departments (EDs). An estimated 220 000 children younger than 5 years are hospitalized every year for treatment of dehydration secondary to acute gastroenteritis. [1][2][3][4][5][6] Current recommendations for the treatment of acute gastroenteritis focus primarily on the correction of dehydration and electrolyte abnormalities. Oral rehydration is the preferred therapy in mild to moderate dehydration, whereas intravenous fluids are recommended in more severe cases. Administration of an antiemetic drug, which could safely suppress vomiting, would be useful in promoting successful oral rehydration. Although several studies have shown some benefit with the use of antiemetic medications, including prochlorperazine, promethazine hydrochloride, and metoclopramide, clinical exp...

A single oral dose of granisetron (2 mg) resulted in equivalent levels of antiemetic protection as I.V. ondansetron (32 mg). Both agents were well tolerated, although more dizziness and abnormal vision were reported with ondansetron. Because the two antiemetic regimens exhibited equivalent efficacies, additional factors such as convenience and cost of therapy should be considered.

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