Children with gastroenteritis may be safely treated with a single dose of an anti-emetic A one-off dose of the anti-emetic, ondansetron, increases the effectiveness of oral rehydration therapy in children with vomiting and diarrhoea, a study shows. Children aged between 3 months and five years recovered two hours more quickly and were only half as […]
Children with gastroenteritis may be safely treated with a single dose of an anti-emetic
A one-off dose of the anti-emetic, ondansetron, increases the effectiveness of oral rehydration therapy in children with vomiting and diarrhoea, a study shows.
Children aged between 3 months and five years recovered two hours more quickly and were only half as likely to have persistent signs of dehydration after four hours of oral fluids compared to those who received placebo – 31% compared with 62%.
Given at a dose of 0.2mg/kg, ondansetron also led to a reduction of vomiting episodes and greater caregiver satisfaction, the RCT in The Journal of Pediatrics showed.
No adverse effects of the treatment were noted in the 170 children.
Ondansetron use also halved the rates children needing intravenous fluids, although this finding failed to meet statistical significance.
“These findings are important in the sense that indiscriminate use of intravenous fluids is very common in diarrhoea, especially when patients also have vomiting,” author Associate Professor Dheeraj Shah, Department of Pediatrics University College of Medical Sciences, India, told The Medical Republic.
A single dose of ondansetron can potentially reduce the failure of ORT and curtain unnecessary intravenous fluids and parental pressure for them in many situations, he said.
An Australian expert Adjunct Associate Professor Michael Fasher, from the department of general practice at the Sydney University, said the drug was used for this group in paediatric emergency departments, but so far generally not in general practice.
This paper was likely to encourage more widespread use in the community setting, said Professor Fasher, who planned to incorporate into his own paediatric practice.
“It’s a novel way of managing a problem which cuts across entrenched teaching, and that entrenched teaching is that you don’t give medicines to children with vomiting and diarrhoea,” Professor Fasher said.
The more commonly used anti-emetics, metoclopramide (Maxolon) and prochlorperazine (Stemetil) carried the risk of extrapyramidal side effects, he told The Medical Republic.
While hospitalisations and deaths from vomiting and diarrhoea in countries like Australia have significantly dropped, “nonetheless there are a group of kids that spend a lot of time in the emergency department and that burden on children and families may well be obviated by earlier use of ondansetron,” Professor Fasher said.
However, he advised sticking to a single dose. “There can be other potential causes that need to be considered and not overlooked by giving repeated doses of ondansetron.”
The Canadian Pediatric Society recommends “considering the use of a single dose of oral ondansetron in children aged six months to 12 years presenting with acute gastroenteritis and vomiting as a prominent symptom, mild to moderate dehydration, or have failed ORT”, the study authors wrote.
The American Academy of Pediatrics, the WHO diarrhoea guidelines and the NICE guidelines do not officially recommend the use of anti-emetics in the management of diarrheal dehydration. But NICE guidelines do suggest oral ondansetron can improve ORT.
