• Lisa Ross DeCamp, Julie S Byerley, Nipa Doshi, and Michael J Steiner.
• Pediatric Education Office, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Campus Box 7593, Chapel Hill, NC 27599, USA. lcr7n@alumni.virginia.edu
• Arch Pediatr Adolesc Med. 2008 Sep 1; 162 (9): 858-65.

ObjectiveTo perform a systematic review and meta-analysis to determine whether taking antiemetic drugs reduces vomiting and decreases the need for further intervention in children with gastroenteritis without causing significant adverse effects.Data SourcesComputerized databases, reference lists, and expert recommendations.Study SelectionProspective controlled trials evaluating medication use in children with vomiting from gastroenteritis.InterventionAntiemetic drug therapy.Main Outcome MeasuresEmesis cessation, use of intravenous fluid for rehydration, hospital admission, return to care, and medication adverse effects.ResultsThe 11 articles that met the inclusion criteria evaluated various antiemetic agents: ondansetron (n = 6), domperidone (n = 2), trimethobenzamide (n = 2), pyrilamine-pentobarbital (n = 2), metoclopramide (n = 2), dexamethasone (n = 1), and promethazine (n = 1). Meta-analysis of 6 randomized, double-masked, placebo-controlled trials of ondansetron demonstrated decreased risk of further vomiting (5 studies; relative risk [RR], 0.45; 95% confidence interval [CI], 0.33-0.62; number needed to treat [NNT] = 5), reduced need for intravenous fluid (4 studies; RR, 0.41; 95% CI, 0.28-0.62; NNT = 5), and decreased risk of immediate hospital admission (5 studies; RR, 0.52; 95% CI, 0.27-0.95; NNT = 14). Diarrheal episodes increased in ondansetron-treated patients in 3 studies. Ondansetron use did not significantly affect return to care (5 studies; RR, 1.34; 95% CI, 0.77-2.35).ConclusionsOndansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis. Future treatment guidelines should incorporate ondansetron therapy for select children with gastroenteritis.

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