Ondansetron reduced the need for intravenous hydration in children with acute gastritis/gastroenteritis and dehydration

ED FROM Roslund G, Hepps TS, McQuillen KK. The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Ann Emerg Med 2008;52:22–9. Correspondence to: Dr G Roslund, St Joseph Regional Medical Center, South Bend, IN, USA; groslund@hotmail.com Source of funding: no external funding. c Clinical impact ratings: Emergency medicine 6/7; Paediatrics 6/7; Paediatric emergency medicine 6/7; Gastroenterology 5/7 Ondansetron v placebo for acute gastritis/gastroenteritis with mild or moderate dehydration in children who failed oral rehydration in the emergency department (ED)* Outcomes in the ED Ondansetron Placebo RRR (95% CI) NNT (CI) Intravenous hydration 22% 55% 60% (32 to 78) 3 (2 to 7) Hospital admission 5.9% 13% 54% (255 to 87) Not significant *Abbreviations defined in glossary. RRR, NNT, and CI calculated from data in article. C O M M EN TA R Y A GE is one of the most common presenting complaints in the paediatric ED. Rehydration is the mainstay of ED therapy, with IV rehydration and possible admission for children who fail a trial of oral rehydration. Traditionally, other therapies have been discouraged, with the noted withdrawal of a vaccine for rotavirus (a common cause of AGE in young children) in the late 1990s, and expert opinion recommending against antiemetics (eg, metaclopramide and promethazine) and antidiarrhoeal agents because of limited efficacy and safety concerns. However, the trial by Roslund et al adds to evidence in support of ondansetron for paediatric ED patients with AGE. It enrolled a population of patients with more acute illness than previous studies (children who had failed an oral rehydration challenge in the ED). There was decreased need for IV hydration with ondansetron, and the overall results were similar to those of other studies and a recent meta-analysis, which also showed decreased risks of persistent vomiting and hospital admission. The only noted side effect of ondansetron was an increased risk of diarrhoea in some studies. Of note, another recent meta-analysis suggests that loperamide is safe and helpful in children . 3 years of age, although its role in combination with ondansetron is unknown. In addition, prevention of some cases of AGE is again possible, as 2 rotavirus vaccines, which appear safe and effective, have recently been approved in the USA and Canada. So, at a time when we are encouraged to stop prescribing drugs for viral upper respiratory infections and otitis media, the evidence suggests that it is time to start prescribing ondansetron for some patients with AGE. Marcia Edmonds, MD University of Western Ontario London, Ontario, Canada 1. DeCamp LR, Byerley JS, Doshi N, et al. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. Arch Pediatr Adolesc Med 2008;162:858–65. 2. Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Med 2007;4:e98. Therapeutics 44 EBM April 2009 Vol 14 No 2