Question 1 Does oral ondansetron reduce vomiting and the need for intravenous fluids and hospital admission in children presenting with vomiting secondary to gastroenteritis? | Archives of Disease in Childhood

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Miscellania

Archimedes

Question 1 Does oral ondansetron reduce vomiting and the need for intravenous fluids and hospital admission in children presenting with vomiting secondary to gastroenteritis?

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The use of ondansetron for the treatment of vomiting in acute gastroenteritis in children: from evidence to clinical use
Federico Marchetti
Published on: 16 November 2010

Published on: 16 November 2010
The use of ondansetron for the treatment of vomiting in acute gastroenteritis in children: from evidence to clinical use
- Federico Marchetti, Clinical Paediatrician
- Other Contributors:
  Luca Ronfani
Sir,
Howard S (1) in the review on the use of oral ondansetron in children with acute gastroenteritis show that the drug produces a statistically significant reduction in the need for intravenous fluids, admissions to hospital, and amount of vomiting in these children.
In the clinical practice antiemetic drugs are frequently used in children with gastroenteritis. A recent retrospective survey that ret...
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Sir,
Howard S (1) in the review on the use of oral ondansetron in children with acute gastroenteritis show that the drug produces a statistically significant reduction in the need for intravenous fluids, admissions to hospital, and amount of vomiting in these children.
In the clinical practice antiemetic drugs are frequently used in children with gastroenteritis. A recent retrospective survey that retrieved data from 4 national and international databases showed that prescription of antiemetic medication varied considerably (2). In particular, between 2% and 23% of children with gastroenteritis received prescriptions for antiemetic medications. The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment (2). A recent survey carried out in Italy showed that 79% of participating clinicians prescribe antiemetic drugs to treat acute gastroenteritis (domperidone in primis followed by metoclopramide) (3). The available evidence showed that a proper evaluation of anti-emetic drugs largely used in clinical practice, such as domperidone, is completely lacking (4). This lack of knowledge about antiemetics is particularly important considering the restricted indications for their use in Italy (this is particularly true for metoclopramide) (5).
Ondansetron, the only antiemetic drug with a favorable profile of efficacy in acute gastroenteritis, was used in a minor proportion of antiemetic prescriptions (2). In Italy, as well as in others European countries, the use of ondansetron to treat vomiting in acute gastroenteritis is not yet authorized, despite evidence supporting its possible use. To ensure clear and concordant information in summary product characteristics of ondansetron, we believe that uniform criteria applied by regulatory agencies could be warranted both at national and European levels.
Federico Marchetti, Luca Ronfani Department of Pediatrics and Service of Epidemiology and Biostatistics, Institute of Child Health, IRCCS Burlo Garofolo, Trieste, Italy
Corresponding Author: Federico Marchetti, MD. Department of Pediatrics, Institute of Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1 34100 Trieste, Italy marchetti@burlo.trieste.it
References
1. Howard S. Archimedes. Question 1. Does oral ondansetron reduce vomiting and the need for intravenous fluids and hospital admission in children presenting with vomiting secondary to gastroenteritis? Arch Dis Child. 2010;95(11):945-7.
2. Pfeil N, Uhlig U, Kostev K, et al. Antiemetic medications in children with presumed infectious gastroenteritis--pharmacoepidemiology in Europe and Northern America. J Pediatr 2008;153(5):659-62
3. Albano F, Bruzzese E, Spagnuolo M, et al. Antiemetics for children with gastroenteritis: off label but still on in clinical practice. J Pediatr Gastroenterol Nutr 2006;43:402-4
4. Alhashimi D, Al-Hashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. 2009;(2):CD005506.
5. Marchetti F, Santuccio C per il gruppo di lavoro sui Farmaci Pediatrico AIFA. Il Trattamento farmacologico del vomito: bilancio tra i rischi e benefici. Bif 2007;5:1-16 http://www.agenziafarmaco.it/allegati/inserto_bif5_2007.pdf
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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