Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department

Freedman, Stephen B.; Adler, Mark; Seshadri, Roopa; Powell, Elizabeth C.

doi:10.1056/nejmoa055119

Cited by 222 publications

(267 citation statements)

References 20 publications

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“…41 Ondansetron usage remained limited to patients who suffered from nausea following chemotherapy until a decade ago when research began to emerge supporting its use in children with acute gastroenteritis. 19,42 Although it is primarily used for children visiting the ED for gastroenteritis, 43 it is not constrained to that group of children. A retrospective study of ondansetron in the ED reported that 38% (n = 12,620) of prescriptions were for reasons other than gastroenteritis in the ED.…”

Section: Discussionmentioning

confidence: 99%

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Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Gravel

Carrière

D’Angelo

et al. 2016

CJEM

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Objectives: Assess the feasibility of a study evaluating one dose of oral ondansetron to decrease post-concussion symptoms at one week and one month following concussion in children aged 8 to 17 years old. Method: This was a pilot study for a randomized, triple-blind controlled trial of one dose of either ondansetron or placebo performed in a tertiary care pediatric emergency department. Participants were children aged 8 to 17 years who sustained a concussion in the previous 24 hours and visited a single emergency department. The outcome of interest was an increase from pre-concussion baseline of at least 3 symptoms from the Post-Concussion Symptom Inventory, measured at one week and at one month following concussion. The primary outcome was to determine the proportion of children who completed the assessment at one week following the intervention. Secondary outcome was the proportion of children who completed the assessment at one month following the intervention. All children, care givers, and those assessing the outcomes were blinded to the group assignment. Results: Of the 218 children presenting with a concussion during the study period, we screened 108 and found 36/108 (33%) eligible to participate and 16/108 (14.8%) agreed to participate. All enrolled patients were compliant with the intervention and follow-up. Conclusion: In our study population, approximately one-third of the screened concussion patients were eligible to participate and approximately one half of those eligible agreed to participate. Our study found that most enrolled patients preferred electronic follow-up; the noncompliance rate was minimal.

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Section: Discussionmentioning

confidence: 99%

“…19 There was no previous study to determine the optimal duration of treatment. Previous studies have failed to show an impact of multiple doses in comparison to a single dose for other disease.…”

Section: Interventionmentioning

confidence: 99%

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Gravel

Carrière

D’Angelo

et al. 2016

CJEM

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“…26 Several studies report ondansetron use in vomiting of gastroenteritis in children. Three studies examined the use of oral ondansetron 21,22,27 and one study examined the use of IV ondansetron 20 for vomiting due to acute gastroenteritis were identified.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have also evaluated the use of ondansetron in children with vomiting from gastroenteritis. 4,[20][21][22] Drug utilization studies of anti-emetic drugs were carried out in Sri Lanka, Italy and multi country trial 6,14,23 similar studies particularly in children is lacking in India so we decided to conduct this study in our hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

Patel

Rana

Patel

et al. 2014

Int J Basic Clin Pharmacol

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“…Recently, a number of pediatric studies have documented the drug's efficacy in treating vomiting secondary to acute gastroenteritis, where it increases the success of oral rehydration therapy and reduces the need for hospitalizations (1,2). Ondansetron has become the preferred antiemetic in children and adults because of its superior efficacy and low rate of adverse events.…”

Section: Introductionmentioning

confidence: 99%

Obtundation and seizure following ondansetron overdose in an infant

George

Al-Duaij

OʼDonnell

et al. 2008

Clinical Toxicology

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Introduction. Ondansetron, an increasingly prescribed 5-HT 3 antagonist used in the management of nausea and vomiting of various etiologies, has a well-established safety profile in therapeutic use. However, little is known about its effects in the setting of an overdose. We describe the first case of severe toxicity in an infant who unintentionally ingested a large quantity of ondansetron. Case report. A 12-month-old infant who ingested seven to eight tablets of his mother's Zofran (ondansetron) ODT 8 mg rapidly developed obtundation and myoclonic movements. While treated by health care providers, he developed seizures, hepatotoxicity, QTc prolongation, and a serotonin syndrome that required endotracheal intubation and intensive care unit management. His clinical status improved over the course of 24 h with supportive care, and he was discharged to home with no sequelae. Discussion. With the increasing popularity of ondansetron among health care providers, particularly for the control of nausea in pregnant women, toddlers in the household may become inadvertently exposed to ondansetron toxicity. This case portrays that, despite the safety of this agent in therapeutic dosage, severe toxicity may be seen in excessive amounts, particularly in infants. Conclusion. Health care providers should recognize the risk for acute toxicity following ondansetron overdose, particularly in infants and toddlers.

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Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department

Abstract: In children with gastroenteritis and dehydration, a single dose of oral ondansetron reduces vomiting and facilitates oral rehydration and may thus be well suited for use in the emergency department.

Cited by 222 publications

References 20 publications

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

Obtundation and seizure following ondansetron overdose in an infant

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