Ondansetron best when an antiemetic is needed in kids with acute gastroenteritis

Last Updated: 2020-03-04

By Reuters Staff

NEW YORK (Reuters Health) - Moderate- to high-quality evidence indicates that ondansetron is the best antiemetic to stop vomiting, prevent hospitalization and the need for intravenous rehydration in children with acute diarrhea and gastroenteritis (ADG), say the authors of a systematic review and meta-analysis.

The analysis, by Dr. Ivan Florez of the University of Antioquia, in Medellin, Colombia, and colleagues, included 24 randomized controlled trials comparing the effectiveness and safety of antiemetics (metoclopramide, ondansetron, domperidone, dexamethasone, dimenhydrinate, and granisetron) in a total of 3,482 children with ADG.

Ondansetron had the largest effect compared with placebo for stopping vomiting (odds ratio, 0.28; 95% credible interval, 0.16 to 0.46; high quality of evidence) and for hospitalization (OR, 2.93; 95% CI, 1.69 to 6.18; moderate quality of evidence), the team reports in Pediatrics.

Ondansetron was also the only antiemetic that reduced the need for intravenous rehydration and was safe.

There is no evidence to support the use of the other antiemetics for stopping vomiting and preventing hospitalization, with their effects classified as "similar or may be similar" to placebo in all the effectiveness outcomes, the researchers note.

Use of antiemetics in children with ADG has been "controversial," they add.

Current clinical practice guidelines (CPGs) from the World Health Organization, the National Institute for Health and Care Excellence, and the American Academy of Pediatrics do not recommend their use. However, the guidelines from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommend ondansetron for ADG in children.

"This disagreement may be due to the lack of updated CPGs in the former organizations that did not consider recent evidence. Therefore, our results may be crucial for future CPG updates," the authors conclude.

Dr. Florez did not respond to a request for comment by press time.

The study had no commercial funding and the authors have no relevant conflicts of interest.

SOURCE: https://bit.ly/2wvTx9P Pediatrics, online March 3, 2020.