Oral ondansetron administration in children seeking emergency department care for acute gastroenteritis

1. Among a cohort of children with gastroenteritis in the emergency department (ED), administration of oral ondansetron was associated with a reduction in index ED visit intravenous fluid administration.

Evidence Rating Level: 2 (Good)

Ondansetron is commonly used in pediatric patients with acute gastroenteritis to reduce vomiting, intravenous fluid rehydration and hospitalization. However, there are conflicting findings in the literature supporting this data. Therefore, this observational study sought to evaluate the association between oral ondansetron administration, oral and intravenous fluid use, hospitalization, and short-term clinical outcomes. It made use of data from children enrolled in 2 trials (PECARN and PERC). 1857 children from these trials were included in this substudy, the median age was 16.0 and 56% were male. Oral ondansetron was administered to nearly half of pediatric patients presenting with acute gastroenteritis. Its use was associated with older age, more vomiting episodes and treatment in the United States as opposed to Canada. The primary objective was to determine if oral ondansetron administration was associated with reduction of intravenous fluid administration, hospitalization at the index visit and within 72 hours, and alterations in the frequency of diarrhea and vomiting episodes during 24 hours following study enrollment. The study found that oral ondansetron administration was associated with a reduction in intravenous fluids at the index ED visit (OR, 0.5; 95% CI, 0.29 – 0.88). In a subset analysis, the study found that in children with dehydration, oral ondansetron administration was also associated with decreased intravenous fluids at index visit. Overall, this study helps support the use of ondansetron in children presenting with acute gastroenteritis. However, clinical trials are needed to further explore and identify children who are most likely to benefit from ondansetron administration.

Click to read the study in Annals of Emergency Medicine

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