Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Sep 7;2011(9):CD005506.
doi: 10.1002/14651858.CD005506.pub5.

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Zbys Fedorowicz  1 , Vanitha A Jagannath, Ben Carter
Affiliations
Meta-Analysis

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Zbys Fedorowicz et al. Cochrane Database Syst Rev. .

Abstract

Background: Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children.

Objectives: To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.

Search strategy: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conferences.The search was re-run and is up to date as on 20 July 2010.

Selection criteria: Randomized controlled trials comparing antiemetics with placebo or no treatment, in children and adolescents under the age of 18, for vomiting due to gastroenteritis.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data.

Main results: We included seven trials involving 1,020 participants. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, NNT 6, 95% CI 4 to 13) and an increase in the proportion of patients with cessation of vomiting (RR 1.34, NNT 5, 95% CI 3 to 7)). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies. In one study the proportion of patients with cessation of vomiting in 24 hours was (58%) with IV ondansetron, (17%) placebo and (33%) in the metoclopramide group (P value = 0.039).

Authors' conclusions: Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting.

PubMed Disclaimer

Conflict of interest statement

There are no financial conflicts of interest and the reviewers declare that they do not have any associations with any parties who may have vested interests in the results of this review. Dr Cathy Bennett is the proprietor of Systematic Research Ltd. and received payment for her contribution to the process of updating an earlier version of the review.

Figures

1
1
Study flow diagram (PRISMA).
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Oral ondansetron (weight dependent dose) vs placebo, outcome: 1.1 Rate of admission to hospital (during ED stay).
5
5
Forest plot of comparison: 1 Oral ondansetron (weight dependent dose) vs placebo, outcome: 1.6 Rate of intravenous rehydration (up to 72 hrs following discharge from the ED stay), worst‐best case scenario.
6
6
Forest plot of comparison: 1 Oral ondansetron (weight dependent dose) vs placebo, outcome: 1.7 Proportion of participants with cessation of vomiting.
1.1
1.1. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 1 Rate of admission to hospital (during ED stay).
1.2
1.2. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 2 Rate of admission to hospital (up to 72 hrs following discharge from ED stay) best‐worst case scenario.
1.3
1.3. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 3 Rate of admission to hospital (up to 72 hrs following discharge from ED stay) worst‐best case scenario.
1.4
1.4. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 4 Rate of intravenous rehydration (during ED stay).
1.5
1.5. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 5 Rate of intravenous rehydration (up to 72 hrs following discharge from the ED stay), best‐worst case scenario.
1.6
1.6. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 6 Rate of intravenous rehydration (up to 72 hrs following discharge from the ED stay), worst‐best case scenario.
1.7
1.7. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 7 Proportion of participants with cessation of vomiting.
1.8
1.8. Analysis
Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 8 Revisit rate.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Cubeddu 1997 {published data only}
    1. Cubeddu LX, Trujillo LM, Talmaciu I, Gonzalez V, Guariguata J, Seijas J, et al. Antiemetic activity of ondansetron in acute gastroenteritis. Alimentary Pharmacology and Therapeutics 1997;11(1):185‐91. - PubMed
Freedman 2006 {published data only}
    1. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. New England Journal of Medicine 2006;354(16):1698‐705. - PubMed
Ramsook 2002 {published data only}
    1. Ramsook C, Sahagun‐Carreon I, Kozinetz CA, Moro‐Sutherland D. A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis. Annals of Emergency Medicine 2002;39(4):397‐403. - PubMed
Roslund 2008 {published data only}
    1. Fedorowicz, Z. Letter to editors. Erratum in. Annals of Emergency Medicine 2008;52(4):406.
    1. Roslund G, Hepps TS, McQuillen KK. The role of oral Ondansetron in children with vomiting as result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Annals of Emergency Medicine 2008;52(1):22‐9. - PubMed
Stork 2006 {published data only}
    1. Stork CM, Brown KM, Reilly TH, Secreti L, Brown LH. Emergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in children. Academic Emergency Medicine 2006;13(10):1027‐33. - PubMed
Uhlig 2009 {published data only}
    1. Uhlig U, Pfeil N, Gelbrich G, Spranger C, Syrbe S, Huegle B, et al. Dimenhydrinate in children with infectious gastroenteritis: a prospective RCT. Pediatrics 2009;124(4):e622‐32. - PubMed
Yilmaz 2010 {published data only}
    1. Yilmaz HL, Yildizdas RD, Sertdemir Y. A randomized clinical trial: oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children. Annals of Emergency Medicine 2008;51(4):482‐3. - PubMed
    1. Yilmaz HL, Yildizdas RD, Sertdemir Y. Clinical trial: oral Ondansetron for reducing vomiting secondary to acute gastroenteritis in children ‐ a double‐blind randomized study. Alimentary Pharmacology and Therapeutics 2010;31(1):82‐91. - PubMed

References to studies excluded from this review

Ginsburg 1980 {published data only}
    1. Ginsburg CM, Clahsen J. Evaluation of trimethobenzamide hydrochloride (Tigan) suppositories for treatment of nausea and vomiting in children. Journal of Pediatrics 1980;96(4):767‐9. - PubMed
Van Eygen 1979 {published data only}
    1. Eygen M, Dhondt F, Heck E, Ameryckx L, Ravensteyn H. A double blind comparison of domperidone and metoclopramide suppositories in the treatment of nausea and vomiting in children. Postgraduate Medical Journal 1979;55(Suppl 1):36‐9. - PubMed

References to studies awaiting assessment

Debray 1990 {published data only}
    1. Debray H, Guihard J, Peyramond D, Tron P. Treatment of vomiting in infants and children induced by acute infectious pathology. A comparative study of alizapride versus metopimazine. Annales de Pediatrie 1990;37(10):683‐7. - PubMed
Reeves 2002 {published data only}
    1. Reeves JJ, Shannon MW, Fleisher GR. Ondansetron decreases vomiting associated with acute gastroenteritis: a randomized, controlled trial. Pediatrics 2002;109(4):e62. - PubMed

References to ongoing studies

NCT00124787 {published data only}
    1. NCT00124787. A trial comparing the effect of oral dimenhydrinate versus placebo in children with gastroenteritis. http://clinicaltrials.gov/ct2/show/NCT00124787 (accessed 14 June 2011).
NCT01165866 {published data only}
    1. NCT01165866. Ondansetron versus metoclopramide in treatment of vomiting in gastroenteritis. http://clinicaltrials.gov/ct2/show/NCT01165866 (accessed 14 June 2011).
NCT01257672 {published data only}
    1. NCT0125762. Symptomatic treatment of acute gastroenteritis. http://clinicaltrials.gov/ct2/show/NCT0125762 (accessed 14 June 2011).

Additional references

AAP1996
    1. Nazarian LF, Berman JH, Brown G, Margolis PA, Matson DO, McClung J, et al. Practice Parameter: the Management of acute gastroenteritis in young children. Pediatrics 1996;97:424‐35. - PubMed
Brown 2006
    1. Brown P, Brunnhuber K, Chalkidou K, Chalmers I, Clarke M, Fenton M, et al. How to formulate research questions. BMJ 2006;333(7572):804‐6. - PMC - PubMed
Brunton 1996
    1. Brunton LL. Agents affecting gastrointestinal water flux and motility; emesis and antiemetics; bile acids and pancreatic enzymes. In: Goodman, Gilman editor(s). The Pharmacological Basis of Therapeutics. 9th Edition. New York: McGraw‐Hill, 1996:928‐932.
Colletti 2009
    1. Colletti JE, Brown KM, Sharieff GQ, Barata IA, Ishimine P. The management of children with gastroenteritis and dehydration in the emergency department. Journal of Emergency Medicine 2010;38(5):686‐98. - PubMed
DeCamp 2008
    1. DeCamp LR, Byerley JS, Doshi N, Steiner MJ. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta‐analysis. Archives of Pediatrics and Adolescent Medicine 2008;162(9):858‐65. - PubMed
Doan 2003
    1. Doan LT, Okitsu S, Nishio O, Pham DT, Nguyen DH, Ushijima H. Epidemiological features of rotavirus infection among hospitalised children with gastroenteritis in Ho Chi Minh City, Vietnam. Journal of Medical Virology 2003;69:588‐94. - PubMed
Downs 1998
    1. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non‐randomised studies of health care interventions. Journal of Epidemiology and Community Health 1998;52:377‐84. - PMC - PubMed
Feldman 1989
    1. Feldman M. Nausea and vomiting. In: Sleisenger MH, Fordtran JS editor(s). Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 4th Edition. Philadelphia, PA: Saunders, 1989:222‐6.
Flake 2004
    1. Flake ZA, Scalley RD, Bailey AG. Practical selection of antiemetics. American Family Physician 2004;69(5):1171. - PubMed
Friedman 1998
    1. Friedman LS, Isselbacher KJ. Nausea, vomiting, and indigestion. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. editor(s). Harrison's Principles of Internal Medicine. 14th Edition. New York: McGraw‐Hill, 1998:230‐2.
Gamble 2005
    1. Gamble C, Hollis S. Uncertainty method improved on best‐worst case analysis in a binary meta‐analysis. Journal of Clinical Epidemiology 2005;58(6):579‐88. - PubMed
Herikstad 2002
    1. Herikstad H, Yang S, Gilder TJ, Vugia D, Hadler J, Blake P, et al. A population ‐ based estimate of the burden of diarrhoeal illness in the United States: FoodNet 1996‐7. Epidemiology and Infection 2002;129(1):9‐17. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. The Cochrane Collaboration.
Kwon 2002
    1. Kwon KT, Rudkin SE, Langdorf MI. Antiemetic use in pediatric gastroenteritis: a national survey of emergency physicians, pediatricians, and pediatric emergency physicians. Clinical Pediatrics 2002;41(9):641‐52. [PUBMED: 12462313] - PubMed
Lexchin 2003
    1. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326(7400):1167‐70. - PMC - PubMed
Li 2003
    1. Li ST, DiGiuseppe DL, Christakis DA. Antiemetic use for acute gastroenteritis in children. Archives of Pediatrics and Adolescent Medicine 2003;157(5):475‐9. [PUBMED: 12742884] - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12. - PubMed
Taylor 1999
    1. Taylor AT. Nausea and vomiting. In: DiPiro JT, Talbert RL, Yee Gl, et al. editor(s). Pharmacotherapy, A Pathophysiologic Approach. 4th Edition. Stanford CT: Appleton & Lange, 1999:586‐96.
Treadwell 2006
    1. Treadwell JR, Tregear SJ, Reston JT, Turkelson CM. A system for rating the stability and strength of medical evidence. BMC Medical Research Methodology 2006;6:52. [DOI: 10.1186/1471-2288-6-52] - DOI - PMC - PubMed
Vreeman 2008
    1. Vreeman RC, Finnell SM, Cernkovich ER, Carroll AE. The effects of antiemetics for children with vomiting due to acute, moderate gastroenteritis. Archives of Pediatrics and Adolescent Medicine 2008;162(9):866‐9. - PubMed