Acute gastroenteritis: from guidelines to real life

Figures & data

Table 1 Summary of randomized controlled trials evaluating the efficacy of ondansetron in acute gastroenteritis

Source	Setting	No.	Age	Inclusion criteria	Antiemetic agent	Route/dose of ondansetron	Outcomes	Side effects	Follow-up
Cubeddu et al 1997^Citation55	Inpatient	36	6 month–8 years	GE and >2 × emesis within 1 hours	Ondansetron/Metoclopramide (0.3mg/kg iv)/isotonic saline	IV 0.3 mg/kg single dose	Vomiting episodes and ORT failure	Increase in diarrhea	24 hrs
Ramsook et al 2002^Citation73	ED	145	6 month–12 years	GE with >5 × vomiting in the preceding 24 hours	Ondansetron (syrup)	PO 6 m – 1 year: 1.6 mg 1–3 year: 3.2 mg/4–12 year: 4 mg Q8H up to 6 doses	Vomiting episodes, receipt of IVF, hospital admission, and diarrheal episode	Increase in diarrhea	24 hrs
Reeves et al 2002^Citation72	ED	107	1 month–22 years	GE and >3 × vomiting in the preceding 24 hours, requiring IV rehydration	Ondansetron	IV 0.15 mg/kg Single dose	Vomiting episodes, hospital admission, duration of vomiting, diarrhea episodes, and return to ED and need for readministration of IVF	No increase in diarrhea	5–7 days
Stork et al 2006^Citation71	ED	137	6 month–12 years	GE, >3 × emesis within past 24 hours, mild to moderate dehydration, and failed oral hydration	Onsansetron/Dexamethasone (1mg/kg)/isotonic saline	IV 0.15 mg/kg Single dose	Hospital admission, ORT tolerance, and degree of dehydration	Not assess the severity of diarrhea	1 and 2 days
Freedman et al 2006^(4)	ED	214	6 month–10 years	GE with mild to moderate dehydration and >1 × vomiting in the preceding 4 hours	Ondansetron (orally dissolving tablet)	PO 8–15 kg: 2 mg 15–30 kg: 4 mg >30 kg: 8 mg Single dose	Vomiting episodes, receipt of IVF, and admission to the hospital	Increase in diarrhea	1–2 weeks
Roslund et al 2008^Citation75	ED	106	1–10 years	GE with mild to moderate dehydration and failed oral rehydration attempt	Ondansetron (orally dissolving tablet)	PO 0.15 mg/kg Single dose	Vomiting episodes, receipt of IVF, hospital admission, diarrheal episodes, and return visit to ED	No increase in diarrhea	1 week
Yilmaz et al 2009^Citation77	ED	109	5 month–8 years	GE with mild to moderate dehydration, >4 × vomiting in 6hr and >4 × diarrhea in 24 hours	Ondansetron (syrup)	PO 0.2 mg/kg Q8H for 3 doses	Vomiting episodes, receipt of IVF, hospital admission, diarrheal episodes, and return visit to ED	Increase in diarrhea	24 hrs

Abbreviations: GE, gastroenteritis; IV, intravenous; PO, per os; ED, emergency department; ORT, oral rehydration therapy; IVF, intravenous fluid.

Table 2 Summary of antiemetic drugs

Drug	No. of RCT	Route/dose	Consideration
Ondansetron	7 RCTs	PO: 2 mg for BW 8–15 kg 4 mg for BW 15–30 kg 8 mg for BW >30 kg IV: 0.1–0.15 mg/kg BW	Minimal adverse effects, with good evidence for reduced admission and intravenous therapy
Dimenhydrinate	1 RCT	PO/PR/IM/IV: 1.25 mg/kg BW	Sedative effect
Promethazine	1 RCT	PO/PR/IM/IV: 0.25–1 mg/kg BW	FDA black box warning
Metoclopramide	2 RCTs	PO/IM/IV: 0.1 mg/kg BW	High frequency of extra-pyramidal reaction
Droperidol	No RCT	IM/IV: 0.05–0.06 mg/kg BW	FDA black box warning
Domperidone	2 RCTs	PO: 0.3–0.6 mg/kg BW PR: <2 yr: 10 mg, 2–6yr: 30 mg, >6 yr: 60 mg	No IV as increase cardiac arrhythmias
Prochlorperazine	No RCT	PO: 0.1–0.2 mg/kg BW PR: 0.1–0.2 mg/kg BW IM: 0.15 mg/kg BW	Not recommended if <2y/IV dosing not recommended in pediatric patients
Trimethobenzamide	2 RCTs	PO: 4–5 mg/kg BW PR: 4–5 mg/kg BW	PR form was removed from the manufacture/IM/IV routes not recommended in pediatric patients

Abbreviations: BW, body weight; PO, per os; PR, per rectum; IM, intramuscular; IV, intravenous; FDA, Food and Drug Administration; RCT, randomized controlled trial.

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RamsookCSahagun-CarreonIKozinetzCAMoro-SutherlandDA randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritisAnn Emerg Med200239439740311919526

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StorkCMBrownKMReillyTHSecretiLBrownLHEmergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in childrenAcad Emerg Med200613101027103316902049

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RoslundGHeppsTSMcQuillenKKThe role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trialAnn Emerg Med2008521222918006189

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