Tuesday, August 23, 2016
Benefits of oral ondansetron in the management of children with dehydrating diarrhoea and vomiting
Oral rehydration therapy (ORT) with oral rehydration solution (ORS) is important for the management of diarrhoeal dehydration. However, its usage is not very popular. According to data from periodic National Surveys from India, ORS is administered in <50% of children during an episode of diarrhoea. Vomiting in children with acute gastroenteritis may cause dehydration and thus health care providers are required to use intravenous fluids, even though it is not indicated. Various trials conducted in developed countries have suggested that anti-emetic agents such as domperidone, metoclopramide, promethazine and ondansetron could be beneficial in children suffering from acute gastroenteritis. However, evidence favouring the use of these anti-emetic agents is lacking.
A double-blind, randomised, placebo-controlled trial published in The Journal of Pediatrics aimed to determine the role of oral ondansetron in successful rehydration of children suffering from acute diarrhoea. A total of 170 children aged 3 months to 5 years suffering from acute diarrhoea, vomiting and some dehydration were enrolled in the study. The participants were randomly assigned to receive either single dose of oral ondansetron (n = 85) or placebo (n = 85) along with standard management of dehydration according to World Health Organization guidelines.
Failure of ORT was significantly lesser in children who received ondansetron than in those who received placebo. Approximately 50% of children received intravenous fluids in the ondansetron group compared to those in the placebo group. However, the difference was not statistically significant. Consumption of oral rehydration solution was considerably more in children receiving ondansetron. A single dose of ondansetron resulted in fewer vomiting episodes, faster rehydration and better caregiver satisfaction.
The findings suggested that administration of ondansetron before initiating ORT could offer better oral rehydration among children aged <5 years with acute diarrhoea and vomiting.
News source - Danewa AS, Shah D, Batra P et al. Oral Ondansetron in Management of Dehydrating Diarrhea with Vomiting in Children Aged 3 Months to 5 Years: A Randomized Controlled Trial. J Pediatr. 2016;169:105–9.