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

Abstract

BACKGROUND

Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics.

OBJECTIVES

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

SEARCH STRATEGY

We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Members of the Cochrane UGPD Group were contacted for details of any ongoing or relevant unpublished clinical trials.

SELECTION CRITERIA

Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects data was collected from the studies.

MAIN RESULTS

Two trials involving 181 participants were included. Although no data were available for the precise time to cessation of vomiting (the primary outcome specified in the protocol for this review), one trial reported that the proportion of patients without vomiting over a 24 hour period was higher in the ondansetron and metoclopramide groups than placebo. In the second trial, ondansetron ensured complete anti-emesis for 8/12 (67%) patients within the first 4 hours and in 7/12 (58%) patients in the first 24 hr period. A few secondary outcomes were reported in the included trials.

AUTHORS' CONCLUSIONS

The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.

Authors+Show Affiliations

Salmaniya Medical Complex, Paediatrics, Box 12, Manama, Bahrain. drdunia@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

16856100

Citation

Alhashimi, D, et al. "Antiemetics for Reducing Vomiting Related to Acute Gastroenteritis in Children and Adolescents." The Cochrane Database of Systematic Reviews, 2006, p. CD005506.
Alhashimi D, Alhashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. 2006.
Alhashimi, D., Alhashimi, H., & Fedorowicz, Z. (2006). Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. The Cochrane Database of Systematic Reviews, (3), CD005506.
Alhashimi D, Alhashimi H, Fedorowicz Z. Antiemetics for Reducing Vomiting Related to Acute Gastroenteritis in Children and Adolescents. Cochrane Database Syst Rev. 2006 Jul 19;(3)CD005506. PubMed PMID: 16856100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. AU - Alhashimi,D, AU - Alhashimi,H, AU - Fedorowicz,Z, Y1 - 2006/07/19/ PY - 2006/7/21/pubmed PY - 2006/10/17/medline PY - 2006/7/21/entrez SP - CD005506 EP - CD005506 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics. OBJECTIVES: To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Members of the Cochrane UGPD Group were contacted for details of any ongoing or relevant unpublished clinical trials. SELECTION CRITERIA: Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects data was collected from the studies. MAIN RESULTS: Two trials involving 181 participants were included. Although no data were available for the precise time to cessation of vomiting (the primary outcome specified in the protocol for this review), one trial reported that the proportion of patients without vomiting over a 24 hour period was higher in the ondansetron and metoclopramide groups than placebo. In the second trial, ondansetron ensured complete anti-emesis for 8/12 (67%) patients within the first 4 hours and in 7/12 (58%) patients in the first 24 hr period. A few secondary outcomes were reported in the included trials. AUTHORS' CONCLUSIONS: The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/16856100/Antiemetics_for_reducing_vomiting_related_to_acute_gastroenteritis_in_children_and_adolescents_ L2 - https://doi.org/10.1002/14651858.CD005506.pub2 DB - PRIME DP - Unbound Medicine ER -