For children with acute gastroenteritis (AGE), ondansetron administered in the primary care setting was found to stop vomiting more quickly than usual care. These findings, from a randomized controlled trial, were published in the British Journal of General Practice.
Patients (N=175) with AGE were recruited at 3 primary care centers in the Netherlands between 2015 and 2018. All children were at risk for dehydration and had ³4 episodes of vomiting during the previous 24 hours. Patients were randomly assigned to receive standard care oral rehydration of 10 mg/kg compensation (n=88) or standard care plus 0.1 mg/kg ondansetron syrup (n=87). Parents reported episodes of vomiting, oral intake, and adverse effects hourly for the first 4 hours after treatment and then daily for 7 days.
Children were aged median 1.5 (IQR, 0.9-2.1) years, 50.3% were girls, vomiting had lasted 2.0 (IQR, 1.0-3.0) days prior to presentation, there were 5.0 (IQR, 4.0-10.0) vomiting episodes during the previous 24 hours, and 71.3% also presented with diarrhea.
Vomiting continued during the first 4 hours after treatment among 42.9% of usual care and 19.5% of ondansetron recipients (relative risk [RR], 0.60; 95% CI, 0.45-0.81). Ondansetron syrup was associated with fewer vomiting episodes (incidence rate ratio [IRR], 0.51; 95% CI, 0.29-0.88).
No significant differences were observed between groups for oral intake (median, 0.0 vs 35.0 mL), referrals (19.2% vs 19.7%), hospital admissions (13.7% vs 15.3%), adverse events (39.6% vs 22.9%), or serious adverse events (8.7% vs 4.4%). There was a significant difference in parent satisfaction, favoring ondansetron syrup (P =.013).
This study was limited by the amount of missing data. The study authors reported having difficultly contacting some parents at day 7 to collect their symptom diaries.
These data indicated that ondansetron syrup in addition to usual care in the primary care setting more effectively stopped vomiting among pediatric patients with AGE compared with usual care alone.
Bonvanie IJ, Weghorst AAH, 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. doi:10.3399/BJGP.2021.0211