What is the treatment for acute gastroenteritis with frequent vomiting?

From the Guidelines

For acute gastroenteritis with frequent vomiting, the primary treatment should focus on preventing dehydration through oral rehydration therapy, and consider using ondansetron for nausea control, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The treatment approach should prioritize the following key points:

• Preventing dehydration through oral rehydration therapy, starting with small sips of clear fluids every 5-10 minutes, gradually increasing volume as tolerated
• Using oral rehydration solutions like Pedialyte, Gatorade, or homemade solutions (1 liter water with 6 teaspoons sugar and 1/2 teaspoon salt)
• Considering ondansetron (Zofran) 4-8mg every 8 hours as needed for nausea control, as it has been shown to reduce vomiting in children and reduce the need for hospitalization for rehydration 1
• Avoiding solid foods initially, then gradually reintroducing bland foods like bananas, rice, applesauce, and toast (BRAT diet) once vomiting subsides
• Resting to aid in recovery
• Avoiding dairy products, caffeine, alcohol, and fatty or spicy foods until fully recovered Some important considerations include:
• Seeking medical attention if severe abdominal pain, bloody vomit or stool, high fever (above 101.5°F), signs of dehydration (decreased urination, extreme thirst, dizziness), or if symptoms persist beyond 2-3 days occur
• Being aware of the potential risks associated with certain medications, such as antimotility and antimicrobial agents, which may increase the risk of complications from diarrhea 1
• Not using loperamide in children under 18 years of age, as it may increase the risk of adverse events, including ileus, abdominal distension, and lethargy 1

From the FDA Drug Label

ONDANSETRON TABLETS USP, for oral use INDICATIONS AND USAGE Ondansetron tablets are a 5-HT 3receptor antagonist indicated for the prevention of: nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. ( 1) nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy ( 1) nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. ( 1) postoperative nausea and/or vomiting. ( 1)

The FDA drug label does not answer the question.

From the Research

Treatment Options for Acute Gastroenteritis with Frequent Vomiting

• The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution 2.
• Antiemetics, such as oral ondansetron, can improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 3, 2, 4, 5.
• Oral ondansetron has been shown to reduce the rate of vomiting, improve the tolerance of oral rehydration, and reduce the need for intravenous rehydration 3, 4, 5.
• Intravenous administration of a dextrose-containing bolus of 0.9% saline may be associated with a greater reduction of circulating ketones and a shorter duration of nausea and vomiting, but it is not followed by a lower rate of hospitalization 3.

Management of Dehydration

• Oral rehydration therapy is the first choice for rehydration in children with acute gastroenteritis and mild-to-moderate dehydration 6, 5.
• Intravenous rehydration should be considered in cases of severe dehydration or hypoglycemia 2.
• The use of oral ondansetron can reduce the need for intravenous rehydration and hospital admission 4, 5.

Role of Probiotics

• Probiotic use amongst children hospitalized following acute gastroenteritis may reduce the mean duration of hospitalization 5.
• However, more studies are needed to determine the optimal organism, dosing, and duration of treatment for probiotics in the treatment of acute gastroenteritis 5.