Oral ondansetron decreases vomiting in children with acute gastroenteritis

Reference

Bonvanie IJ, Weghorst AA, Holtman GA, et al. Oral ondansetron for paediatric gastroenteritis in primary care: a randomised controlled trial. Br J Gen Pract 2021;71(711):e728-e735.

Synopsis

For this pragmatic trial in primary care settings, the investigators enrolled 175 children with acute gastroenteritis who were at risk of dehydration (aged 6 months to 6 years with 4 or more episodes of vomiting within 24 hours and at least 1 episode of vomiting within 4 hours of presentation). The researchers randomized the children to receive control therapy (oral rehydration therapy of 10 mL/kg unless the clinician thought they child was already dehydrated, in which case they used 15 mL/kg for 4 hours) or oral ondansetron syrup (0.1 mg/kg; administered as a single dose and repeated only once if the child vomited within 15 minutes of administration). The parents completed symptom diaries hourly for the first 4 hours after presentation, then once daily for 1 week. Fewer ondansetron-treated children continued to vomit within the first 4 hours after randomization (19.5% vs. 42.9%; number needed to treat = 5; 95% CI 4 - 15); however, the rate of referrals to the emergency department (19.4%) and hospitalizations (14.4%) were not significantly decreased. Although the rate of adverse events (31.3%) and serious adverse events (6.6%) were similar between the 2 groups, parental satisfaction was slightly higher among the children treated with ondansetron.