#49 Can ondansetron help children vomiting due to gastroenteritis?
CLINICAL QUESTION
In children presenting with vomiting associated with gastroenteritis, what are the benefits and harms of ondansetron?
BOTTOM LINE
While most cases of pediatric gastroenteritis are self-limiting, studies from the emergency setting show a single dose of oral ondansetron can help reduce vomiting, the need for IV fluids and admission.
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EVIDENCE
Systematic review,1 six Randomized Controlled Trials (RCTs), five in emergency department (ED) and one inpatient, 745 patients total, oral and IV administration.
- Ondansetron statistically significantly improved:
- Admission: Ondansetron (7.5% versus placebo 14.6%) Number Needed to Treat (NNT)=14.
- Need for IV fluids: (13.9% versus 33.9%) NNT=5.
- Continued vomiting in ED: (16.9% versus 37.8%) NNT=5.
- No change in return to care.
- Increased diarrhea (no numbers given).
- Only oral treatments were meta-analyzed and had similar results.
- Statistically significant reduction in admission (NNT=17), need for IV rehydration (NNT=5), persistent vomiting (NNT=5) but no reduction in return to care.
- Evidence for other medications for vomiting due to gastroenteritis in pediatrics is poor and/or limited.1,6
- More recent RCT found dimenhydrinate suppositories helped stop vomiting (NNT=5) but did not reduce admission rates.7
- Ondansetron appears cost-effective in ED setting.8,9
- An evidence-based review of ondansetron for gastroenteritis by the Canadian Pediatric Society10 recommended:
- A single oral dose ondansetron for children (age six months to 12 years):
- With mild to moderate dehydration or failed oral rehydration, and
- Not predominantly moderate to severe diarrhea.
- A single oral dose ondansetron for children (age six months to 12 years):
- Ondansetron can be administered IV or orally (dissolving formulations available)
- Oral doses example: 2 mg if patient weighs 8-15 kg, 4 mg if 15-30 kg, and 6-8 mg if >30 kg.
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