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JOURNAL WATCH PEDIATRICS & ADOLESCENT MEDICINE

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Selections from Journal Watch Pediatrics and Adolescent MedicineCopyright © 2006 Massachusetts Medical Society. All rights reserved.

ANTIEMETIC DRUG ENHANCES ORAL REHYDRATION

▸ Oral rehydration therapy is underused for children with gastroenteritis, particularly when vomiting is their major symptom. In a partially industry-supported, double-blind clinical trial, investigators in a Chicago pediatric emergency department randomized 215 children (age range, 6 months to 10 years) with gastroenteritis to receive either single doses of the antiemetic drug ondansetron (Zofran) or placebo. Children who vomited within 15 minutes of administration received second doses. Each child received 1 hour of oral rehydration that began 15 minutes after study drug administration.

Compared with children who received placebo, significantly fewer children who received ondansetron vomited (35% vs. 14%) or required intravenous hydration (31% vs. 14%). No significant differences were found in hospitalization rates (5% and 4%) or rates of additional emergency department visits (22% and 19%). Children who received ondansetron had more episodes of diarrhea during oral rehydration than did those who received placebo (mean, 1.4 vs. 0.5).

Comment

▸ Ondansetron appears to be safe for children, and its administration results in more effective oral rehydration. A much larger study would be required to determine whether ondansetron therapy results in fewer hospitalizations, but the reduced requirement for IV hydration shown in this study is also an important outcome. This drug probably could be used successfully in the primary care setting.

Howard Bauchner, MD

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