Ondansetron is Superior to Domperidone for Vomiting in Children with Gastroenteritis
Ondansetron is more effective than domperidone in alleviating vomiting in children with gastroenteritis and should be the preferred antiemetic agent for this indication. 1, 2
Comparative Efficacy of Ondansetron vs. Domperidone
- Ondansetron significantly reduces the risk of continued vomiting in children with gastroenteritis compared to domperidone, with 95% of children showing improvement at 24 hours with ondansetron versus 85% with domperidone (p=0.01) 1
- In a multicenter double-blind randomized controlled trial, ondansetron reduced the need for intravenous rehydration by over 50% compared to domperidone (RR 0.47,98.6% CI 0.23-0.97), demonstrating superior efficacy 2
- Domperidone was not found to be effective for the symptomatic treatment of vomiting during acute gastroenteritis in children when compared to placebo 2
Evidence Supporting Ondansetron Use
- The Infectious Diseases Society of America (IDSA) clinical practice guidelines recommend ondansetron as an antiemetic to facilitate oral rehydration in children >4 years of age with acute gastroenteritis associated with vomiting 3
- A single oral dose of ondansetron (0.15 mg/kg) reduces gastroenteritis-related vomiting and facilitates oral rehydration therapy without significant adverse events 4
- Ondansetron decreases the proportion of children who continue vomiting within 4 hours from 42.9% to 19.5% (NNT = 4) 4
- Meta-analysis data shows ondansetron produces a higher chance of vomiting cessation within 8 hours (RR 1.41,95% CI 1.19-1.68) compared to placebo 5
Benefits of Ondansetron in Gastroenteritis Management
- Ondansetron significantly reduces the risk of oral rehydration therapy failure (RR 0.43,95% CI 0.34-0.55) and intravenous hydration needs (RR 0.44,95% CI 0.34-0.57) 5
- Use of ondansetron is associated with decreased hospitalization rates within 8 hours (RR 0.49,95% CI 0.32-0.75) 5
- Ondansetron improves overall parental satisfaction with treatment in children with gastroenteritis 4
Clinical Application and Dosing
- Ondansetron should be administered at a dose of 0.15 mg/kg orally for children with gastroenteritis and vomiting 1, 4, 2
- Ondansetron should be considered when vomiting hinders oral rehydration therapy, which is the cornerstone of gastroenteritis management 3, 6
- The American Academy of Pediatrics recommends weight-based dosing of ondansetron for pediatric patients with persistent vomiting due to its efficacy and favorable side effect profile 7
Important Considerations and Limitations
- Antiemetic treatment should not replace appropriate fluid and electrolyte therapy, which remains the mainstay of treatment for gastroenteritis 3
- Ondansetron should be used after ensuring adequate hydration or alongside rehydration efforts 3
- While no significant adverse events were reported in most studies, clinicians should be aware that diarrhea has been reported as a side effect of ondansetron treatment in several studies 3
- Special caution might be warranted in children with heart disease due to the potential of ondansetron to prolong the QT interval 3
In conclusion, based on the most recent and highest quality evidence, ondansetron demonstrates superior efficacy to domperidone in treating vomiting in children with gastroenteritis and should be the preferred antiemetic agent for this indication.