Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis

Area of Science:

• Pediatric Emergency Medicine
• Gastroenterology
• Clinical Pharmacology

Background:

• Ondansetron is used in emergency departments for children with acute gastroenteritis-associated vomiting.
• Limited evidence supports its use for reducing symptoms after discharge.

Purpose of the Study:

• To evaluate the effectiveness of ondansetron prescribed at discharge for children with acute gastroenteritis-associated vomiting.
• To determine if ondansetron reduces the risk of moderate-to-severe gastroenteritis after emergency department care.

Main Methods:

• A double-blind, randomized superiority trial was conducted in six pediatric emergency departments.
• 1030 children (6 months to 18 years) received either oral ondansetron or placebo for 48 hours post-enrollment.
• The primary outcome was moderate-to-severe gastroenteritis (modified Vesikari scale score ≥9) within 7 days.

Main Results:

• Ondansetron use was associated with a lower risk of moderate-to-severe gastroenteritis (adjusted odds ratio, 0.50; 95% CI, 0.40 to 0.60).
• The number of vomiting episodes within 48 hours was lower with ondansetron (adjusted rate ratio, 0.76; 95% CI, 0.67 to 0.87).
• No significant differences were observed in vomiting presence, duration, unscheduled visits, IV fluid receipt, or adverse events.

Conclusions:

• Ondansetron provision after an emergency department visit reduced the risk of moderate-to-severe gastroenteritis in children over 7 days.
• The findings support the use of ondansetron for managing pediatric gastroenteritis-associated vomiting post-discharge.