Oral Ondansetron versus Domperidone for Acute Gastroenteritis Associated Vomiting in Young Children

Abstract

The management of vomiting and antiemetic therapy in young children with acute gastroenteritis (AGE) has not been standardized by any management guidelines. Antiemetic drugs including promethazine, prochlorperazine, metoclopramide, ondansetron, and domperidone are readily used in the emergency departments (EDs). The aim of this study was to compare the efficacy of ondansetron with domperidone in cessation of vomiting in pediatric AGE. Methods This open-label, two-arm trial was conducted in a pediatric ED in Pakistan. Children of age 1 to 60 months presenting with acute vomiting and no or mild-to-moderate dehydration associated with AGE were randomized into two groups. Group A children received ondansetron suspension orally at a dose of 0.15 mg/kg body weight. Group B received domperidone suspension orally at a dose of 0.5 mg/kg body weight. The primary outcome was the number of children in each group who did not have any episode of vomiting 24 hours posttreatment. The data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) for Windows version 20.0 (IBM Corp., Armonk, NY). Results At 6 hours, 87% of children in the ondansetron group improved and their vomiting episodes ceased as compared to 81% of children in the domperidone group. The differences were statistically insignificant (p>0.05). At 24 hours, 95% in the ondansetron group had improved and only 85% in the domperidone group. The results were statistically significant favoring the end results of the ondansetron (p=0.01). Conclusions This study concluded that ondansetron is more efficacious than domperidone in cessation of vomiting associated with AGE and no or mild-to-moderate dehydration in children of age three months to five years.

Comparison of Ondansetron versus Domperidone for treating vomiting in acute gastroenteritis in children at a resource limited setting of South Punjab, Pakistan

“…A local study from Karachi evaluating efficacy of Domperidone versus Ondansetron among children below five years of age with AGE shared that 13.1% children Ondansetron group had persistence of vomiting at six hours following treatment while 18.8% in Domperidone group had persistence of vomiting (p=0.21). 9 In this study, Ondansetron proved to be significantly more effective versus Domperidone aiming cessation of vomiting at 24-hours follow up (89.4% versus 80.6%, p=0.0390). A study from Thailand by Rerksuppaphol S et al analyzing efficacy of Domperidone (at a dose of 2.5mg for children weighing below 15kg, 5mg for 15-30kg and 10 for more than 30kg) versus Ondansetron (2mg for children weighing below 15kg, 4mg for 15-30kg and 8mg for more than 30kg) among 73 children up to 15 years of age with AGE found that cessation of vomiting was noted 62% children in Ondansetron group and 44% in Domperidone group (p=0.16).…”

“…8 A local study from Karachi evaluating effectiveness of Ondansetron versus Domperidone aiming cessation of vomiting among children below five years of age revealed that at 24 hours, 95% of children with Ondansetron administration had cessation of vomiting in comparison to 85% with Domperidone (p=0.01). 9 Informed written consent was sought from parents/guardians of all study participants. A sample of 284 (142 in each group) considering 2-sided confidence level as 95%, power 80%, ratio of cases to control as 1, proportion of children with cessation of vomiting with Domperidone as 85% and cessation of vomiting with Ondansetron as 95%.…”

“…A sample of 284 (142 in each group) considering 2-sided confidence level as 95%, power 80%, ratio of cases to control as 1, proportion of children with cessation of vomiting with Domperidone as 85% and cessation of vomiting with Ondansetron as 95%. 9 Inclusion criteria was children of both genders aged below 12 years of age having three or more non-bilious, non-bloody vomiting episodes within 24 hours and with suggestive signs and symptoms of AGE. Sign and symptoms of AGE consisted of diarrhea with or without fever, abdominal pain and bloating/discomfort.…”

Outcomes of ondansetron use in children with gastroenteritis in the emergency department: a literature review

“…However, [practice observed by the author] suggests that clinicians often depart from the NICE guidelines (2009) and prescribe and administer an antiemetic for the treatment of paediatric gastroenteritis, in particular ondansetron. Hanif et al (2019) highlighted that the treatment of gastroenteritis in young children in the UK is controversial [because] there is no standardised management of antiemetic administration. Other authors (Fedorowicz et al 2011, Thompson et al 2016 agree that there appears to be a lack of consensus among clinicians about indications for administering antiemetics [for the treatment of gastroenteritis in children].…”

“…Other authors (Fedorowicz et al 2011, Thompson et al 2016 agree that there appears to be a lack of consensus among clinicians about indications for administering antiemetics [for the treatment of gastroenteritis in children]. The topic is current and there is a considerable amount of recent research (Danewa et al 2016, Freedman et al 2019a, 2019b, Hanif et al 2019, Romano et al 2019.…”