Use of Antiemetic Agents in Acute Gastroenteritis

Abstract

Ondansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis. Future treatment guidelines should incorporate ondansetron therapy for select children with gastroenteritis.

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

“…Thus, to reduce variability across hospitals and focus on the impact of increasing ondansetron use, hospitals were included only if they progressed through periods of low (<5% of patients with AGE receiving ondansetron) to medium (5%-25%) to high (>25%) ondansetron use. Category cut points were selected based on the following: (1) extremely limited ondansetron use (<5%) prior to 2000; (2) the number needed to treat to prevent 1 child from receiving IV rehydration (number needed to treat = 5; 95% CI, 4-8) 8 ; and (3) knowledge that efficacy studies may overestimate effectiveness by incorporating features maximizing the chance of finding a difference in the shortest possible time at the lowest possible cost. Hence, a significant increase in use may be required to see a clinically significant reduction in IV rehydration rates.…”

“…[8][9][10] Studies have demonstrated efficacy of ondansetron in children with mild to moderate dehydration who had initially failed ORT 9,11 and in those with multiple episodes of vomiting prior to ED presentation. 12 Although now administered to more than 50% of children with AGE in US EDs, 13 its administration is not recommended in guidelines endorsed by the American Academy of Pediatrics.…”

Management guidelines for acute infective diarrhoea / gastroenteritis in infants

“…16 Cyclizine and prochlorperazine have not proven useful and may carry a higher risk of toxic side-effects in young infants, and in the Background. Acute onset vomiting and diarrhoea is one of the most common illnesses of infancy, and is second only to respiratory illnesses as a cause of childhood deaths worldwide.…”

“…Metoclopramide should be considered in severe pain, at a dose of 0.1 mg/kg of body mass to a maximum of 10 mg; a total daily dose of 0.5 mg/kg should not be exceeded. 16 The extrapyramidal side-effects of metoclopramide in young infants should warrant caution. Frequent small oral sips of a clear hypotonic glucose-containing fluid correct ketosis and prevent gastric overdistension, in addition to contributing to rehydration.…”

Consensus Guideline on Acute Gastroenteritis in the Emergency Department. Emergency Medicine Committee of SLACIP (Latin American Society of Pediatric Intensive Care)

“…y la hospitalización inmediata. El uso debe ser evaluado (3,5,41,42,43). en paciente con factores de riesgo de arritmia LOPERAMIDA Aunque la loperamida parece disminuir la persistencia de la diarrea aguda en niños, no se recomienda su uso debido a que el riesgo de efectos (5,41).…”