From the Guidelines
For infants, ondansetron is the recommended anti-emetic, with a dosage of 0.15 mg kg-1 every 8 hours, as suggested by the most recent guidance from the European Society for Paediatric Anaesthesiology 1. When considering anti-emetic medication for infants, it's crucial to weigh the benefits against potential risks, given the limited data on medication use in this age group.
- The dosage of ondansetron, as per the latest study, is 0.15 mg kg-1 every 8 hours 1.
- Other options like dexamethasone and metoclopramide have different dosage recommendations, with dexamethasone at 0.15 mg kg-1 every 12 hours and metoclopramide at 0.1 mg kg-1, but ondansetron is specifically highlighted for its efficacy and safety profile in infants 1.
- It's essential to note that metoclopramide should not be combined with tramadol and is not recommended for infants under 1 year old, further supporting the preference for ondansetron in this age group 1.
- Before administering any medication, ensuring proper hydration through oral rehydration solutions and monitoring for signs of dehydration is vital.
- The use of anti-emetics in infants should always be under the guidance of a pediatrician, as the underlying cause of vomiting needs to be evaluated, and some conditions may require alternative approaches.
From the Research
Anti-emetic Options for Infants
- Ondansetron is a commonly used anti-emetic in children, and its efficacy has been demonstrated in various studies 2, 3, 4, 5, 6.
- It is a selective serotonin (5-hydroxytryptamine; 5-HT) 5-HT3 receptor antagonist, which makes it effective in preventing nausea and vomiting in children undergoing chemotherapy, radiotherapy, and surgery 2.
- In comparative trials, ondansetron was significantly more effective at reducing nausea and vomiting than metoclopramide or chlorpromazine, although the incidence of delayed symptoms were similar between children receiving ondansetron and metoclopramide 2.
Efficacy in Gastroenteritis-related Vomiting
- Ondansetron has been shown to be effective in reducing gastroenteritis-related vomiting and facilitating oral rehydration therapy (ORT) in children 3, 4.
- A single oral dose of ondansetron has been shown to reduce the risk of recurrent vomiting, the need for intravenous fluids, and hospital admissions in children with acute gastroenteritis 4.
Safety and Tolerability
- Ondansetron is generally well tolerated in children, with mild to moderate headache, constipation, and diarrhea being the most frequently reported adverse events 2, 6.
- The overall incidence of adverse events is low, and ondansetron is considered a safe and effective anti-emetic in children 2, 6.
Clinical Use
- Ondansetron can be used as a first-line anti-emetic in children undergoing chemotherapy, radiotherapy, and surgery, as well as in the treatment of gastroenteritis-related vomiting 2, 3, 4.
- The clinical use of ondansetron can be defined as "off-label/on evidence," meaning that it is used outside its authorized drug label but with sufficient evidence to support its use in children 4.