Role of Antiemetic Drugs for the Treatment of Acute Gastroenteritis in Children

Rachel C. Vreeman

Disclosures

Pediatr Health. 2009;3(4):337-341. 

In This Article

Vomiting & Acute Gastroenteritis Common Among Children

Acute gastroenteritis (AGE) is a common childhood illness.[1,2] It is estimated that, worldwide, children younger than 5 years of age experience 3-5 billion cases of AGE each year.[3] In the USA, over 200,000 children under 5 years of age are admitted to hospital as a result of AGE-related dehydration; thus, AGE is responsible for 13% of hospitalizations in this age group.[2,4] AGE also results in more than 1.5 million outpatient visits per year in the USA,[5] with approximately 374,000 outpatient visits per year in the USA for rotavirus-related AGE alone.[6] Since AGE results in such a high burden of outpatient visits and inpatient visits, the estimated costs of caring for patients with AGE in the USA are more than US$180 million dollars per year for rotavirus hospitalizations alone,[2] with direct and indirect costs of approximately US$1 billion per year.[7] While AGE seldom results in pediatric deaths in high-income countries, AGE causes between 1.4 and 2.5 million deaths per year in children living in resource-limited settings.[8,9]

The etiology of AGE is most often viral in children. Rotavirus is the most common cause of hospitalizations for AGE among children in the USA.[7] AGE typically results in acute diarrhea; however, many children also experience nausea, vomiting, fever and abdominal pain. Vomiting is a common initial symptom of AGE in the initial phases of viral AGE.[3] Vomiting may be more common among young children with AGE than older children.[10] In AGE caused by rotavirus, more than 75% of children have vomiting in the first 3 days of the illness.[11] Vomiting in AGE contributes to dehydration through direct fluid losses; however, it may also make it more difficult to implement oral rehydration therapy. Moreover, many physicians believe vomiting is a contraindication to using oral rehydration therapy and favor using intravenous fluids for mild or moderate dehydration when children have vomiting.[12] Vomiting related to AGE may also be a source of psychological and physical distress for parents and children,[13] with some parents linking vomiting with more severe illness.[14] In addition, persistent vomiting can lead to even more distressing procedures, including needle sticks for intravenous placement or laboratory assessments and hospitalization.[15]

Although children with AGE frequently have vomiting, current practice recommendations for pediatric AGE do not include pharmacologic treatment for vomiting.[1] Since vomiting in AGE is self-limited, owing to the efficacy of oral and intravenous rehydration therapy for AGE-related dehydration, and given the potential for adverse side effects from antiemetic medications, their use is not routinely recommended for children with AGE and vomiting. However, many physicians in developed countries do prescribe antiemetics for children with AGE and vomiting.[16] In a study reviewing prescribing practices in Europe and North America for children 0-9 years of age with AGE, between 2 and 23% of children with AGE received prescriptions for antiemetic medications.[17] Accumulated evidence supports the use of specific antiemetic medications for children with AGE.[18,19,20]

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