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Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis.
Pediatrics. 2020 04; 145(4)Ped

Abstract

CONTEXT

Several antiemetics have been used in children with acute gastroenteritis. However, there is still controversy over their use.

OBJECTIVE

To determine the effectiveness and safety of antiemetics for controlling vomiting in children with acute gastroenteritis.

DATA SOURCES

Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Latin America and the Caribbean Literature on Health Sciences, and gray literature, until December 2018.

STUDY SELECTION

We selected randomized clinical trials comparing metoclopramide, ondansetron, domperidone, dexamethasone, dimenhydrinate, and granisetron.

DATA EXTRACTION

Two reviewers independently screened abstracts and full texts, extracted the data, and assessed the risk of bias. We performed pairwise and network meta-analysis using the random-effects model.

RESULTS

Twenty-four studies were included (3482 children). Ondansetron revealed the largest effect in comparison to placebo for cessation of vomiting (odds ratio = 0.28 [95% credible interval = 0.16 to 0.46]; quality of evidence: high) and for hospitalization (odds ratio = 2.93 [95% credible interval = 1.69 to 6.18]; quality of evidence: moderate). Ondansetron was the only intervention that reduced the need for intravenous rehydration and the number of vomiting episodes. When considering side effects, dimenhydrinate was the only intervention that was worse than placebo.

LIMITATIONS

Most treatment comparisons had low- or very low-quality evidence, because of risk of biases and imprecise estimates.

CONCLUSIONS

Ondansetron is the only intervention that revealed an effect on the cessation of vomiting, on preventing hospitalizations, and in reducing the need for intravenous rehydration. Ondansetron was also considered a safe intervention.

Authors+Show Affiliations

Department of Pediatrics, University of Antioquia, Medellín, Colombia. Hospital Pablo Tobón Uribe, Medellín, Colombia.Department of Public Health, Universidad del Norte, Barranquilla, Colombia.Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, London, United Kingdom; and.Department of Pediatrics, University of Antioquia, Medellín, Colombia; ivan.florez@udea.edu.co. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32132152

Citation

Niño-Serna, Laura F., et al. "Antiemetics in Children With Acute Gastroenteritis: a Meta-analysis." Pediatrics, vol. 145, no. 4, 2020.
Niño-Serna LF, Acosta-Reyes J, Veroniki AA, et al. Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis. Pediatrics. 2020;145(4).
Niño-Serna, L. F., Acosta-Reyes, J., Veroniki, A. A., & Florez, I. D. (2020). Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis. Pediatrics, 145(4). https://doi.org/10.1542/peds.2019-3260
Niño-Serna LF, et al. Antiemetics in Children With Acute Gastroenteritis: a Meta-analysis. Pediatrics. 2020;145(4) PubMed PMID: 32132152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiemetics in Children With Acute Gastroenteritis: A Meta-analysis. AU - Niño-Serna,Laura F, AU - Acosta-Reyes,Jorge, AU - Veroniki,Areti-Angeliki, AU - Florez,Ivan D, Y1 - 2020/03/04/ PY - 2020/01/22/accepted PY - 2020/3/7/pubmed PY - 2020/6/27/medline PY - 2020/3/6/entrez JF - Pediatrics JO - Pediatrics VL - 145 IS - 4 N2 - CONTEXT: Several antiemetics have been used in children with acute gastroenteritis. However, there is still controversy over their use. OBJECTIVE: To determine the effectiveness and safety of antiemetics for controlling vomiting in children with acute gastroenteritis. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Latin America and the Caribbean Literature on Health Sciences, and gray literature, until December 2018. STUDY SELECTION: We selected randomized clinical trials comparing metoclopramide, ondansetron, domperidone, dexamethasone, dimenhydrinate, and granisetron. DATA EXTRACTION: Two reviewers independently screened abstracts and full texts, extracted the data, and assessed the risk of bias. We performed pairwise and network meta-analysis using the random-effects model. RESULTS: Twenty-four studies were included (3482 children). Ondansetron revealed the largest effect in comparison to placebo for cessation of vomiting (odds ratio = 0.28 [95% credible interval = 0.16 to 0.46]; quality of evidence: high) and for hospitalization (odds ratio = 2.93 [95% credible interval = 1.69 to 6.18]; quality of evidence: moderate). Ondansetron was the only intervention that reduced the need for intravenous rehydration and the number of vomiting episodes. When considering side effects, dimenhydrinate was the only intervention that was worse than placebo. LIMITATIONS: Most treatment comparisons had low- or very low-quality evidence, because of risk of biases and imprecise estimates. CONCLUSIONS: Ondansetron is the only intervention that revealed an effect on the cessation of vomiting, on preventing hospitalizations, and in reducing the need for intravenous rehydration. Ondansetron was also considered a safe intervention. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/32132152/Antiemetics_in_Children_With_Acute_Gastroenteritis:_A_Meta_analysis_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=32132152 DB - PRIME DP - Unbound Medicine ER -