Gastroenteritis, including viral gastroenteritis, is a major cause of death among children under 5 years of age in resource-limited settings.[35,36,37,38] In the face of over a million pediatric deaths per year from gastroenteritis in these settings, research on the efficacy and cost-effectiveness of antiemetics for children with gastroenteritis in resource-limited settings should be considered. The first priority should be to provide access to clean water and effectively scale up the use of oral rehydration therapy. However, there may be a role for other therapeutic options such as ondansetron. Ondansetron is rarely used in these settings owing to its high cost. Although ondansetron is comparatively expensive, it may reduce the need for intravenous fluids and hospital admissions. Thus, ondansetron may be a useful complement to oral rehydration therapy for critically ill children. While priority should be placed on access to clean water and effective oral rehydration, ondansetron may be a secondary strategy for reducing morbidity and mortality from AGE. Options that would lower the cost of antiemetic agents in resource-limited settings might further contribute to the cost-effectiveness of this strategy.
Diarrhea was a documented side effect reported in several of the ondansetron studies. Since the existing studies varied widely with regard to duration of symptoms, as well as length of follow-up, their data could not be pooled to further investigate this side effect. Further evaluations of the side effects of ondansetron, particularly in increasing diarrhea, are needed. Moreover, as AGE is such a common condition in children, ondansetron may become a frequently used treatment in emergency departments in settings such as the USA. Over the next decade, in the setting of widespread use, even very rare side effects of ondansetron may be important and careful surveillance must be implemented to monitor for adverse events in children. Investigation of the effectiveness and adverse events of ondansetron in widespread use will be needed and should be conducted by investigators independently from pharmaceutical industry support.
Finally, investigators need to continue to provide us with research that evaluates the outcomes of the most relevance to our patients and their families. Investigations of the length of time from the start of a therapy until the cessation of vomiting should be included, along with the measures of how many episodes of vomiting the child experiences. Investigating parent expectations and values in terms of both cessation of vomiting and potential increases in diarrhea also need to be considered. Cost-effectiveness analyses to further guide policy-makes would also be a helpful addition to the literature.
Rachel C. Vreeman, Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, HITS 1020, Indianapolis, IN, USA Tel.: +1 317 278 0552 Fax: +1 317 278 0456 firstname.lastname@example.org
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Pediatr Health. 2009;3(4):337-341. © 2009 Future Medicine Ltd.
Cite this: Role of Antiemetic Drugs for the Treatment of Acute Gastroenteritis in Children - Medscape - Aug 01, 2009.