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In a double-blind, randomized trial of 1,030 children aged 6 months to 18 years with acute gastroenteritis–associated vomiting, researchers found multidose ondansetron administered at home as needed after emergency department (ED) discharge significantly reduced the incidence of moderate-to-severe gastroenteritis during the subsequent 7 days. Among participants with complete follow-up, 5.1% of the ondansetron group experienced moderate-to-severe gastroenteritis (modified Vesikari score 9 or above) compared to 12.5% in the placebo group (adjusted odds ratio, 0.50; 95% confidence interval [CI], 0.40–0.60). Ondansetron also reduced vomiting episodes in the first 48 hours (adjusted rate ratio, 0.76; 95% CI, 0.67–0.87), though differences in overall vomiting occurrence and duration were not statistically meaningful. Adverse events, including diarrhea, did not differ significantly, but kids receiving 3 or more doses had a slightly increased rate of diarrheal stools (rate ratio, 1.36; 95% CI, 1.03–1.80).Â
Why it matters: Every year, about 2 million U.S. children present to EDs for acute gastroenteritis, and as many as 95% of them present with vomiting. The authors state that prescribing ondansetron after an ED visit led to lower risk of moderate-to-severe gastroenteritis during the subsequent 7 days, however, they also say that the majority of children who receive ondansetron in the ED do not have recurrence of vomiting after discharge.
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