Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD005506.

Alhashimi D, Al-Hashimi H, Fedorowicz Z.

Paediatrics, Salmaniya Medical Complex, Box 12, Manama, Bahrain.

BACKGROUND: Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics. 

OBJECTIVES: To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. 

SEARCH STRATEGY: We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Cochrane UGPD Group members were contacted for details of any ongoing or relevant unpublished clinical trials. The search was re-run on 12th July 2006 and 24th June 2008 and two further trials were found. 

SELECTION CRITERIA: Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis. 

DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study investigators were contacted for additional information. 

MAIN RESULTS: Four trials involving 501 participants were included. No data was available for the precise time to cessation of vomiting: one trial reported a higher proportion of patients without vomiting over 24 hours in the ondansetron and metoclopramide groups than placebo. Oral ondansetron in one trial ensured cessation of emesis for 8/12 (67%) patients within the first 4 hours and 7/12 (58%) patients in the first 24 hr period. In one trial 14% of patients who received oral ondansetron vomited during oral rehydration compared to 35% to the placebo group. In a further trial intravenous rehydration was required in 21.6% (ondansetron group) versus 54.5% (placebo group) P< 0.001. 

AUTHORS’ CONCLUSIONS: The small number of included trials provided some limited evidence favouring the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.

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