Managing paediatric gastroenteritis in primary care: is there a role for ondansetron?

Abstract

Despite the reduction in hospital admissions1 and deaths2 due to the rotavirus vaccine, acute gastroenteritis remains a major cause of morbidity and healthcare service use worldwide. While typically a self-limited illness, the mainstay of therapy is oral rehydration therapy (ORT) to prevent the need for intravenous fluids and hospital admission due to severe dehyration.3 In 2006, a randomised controlled trial (RCT) by Freedman et al showed that a single dose of ondansetron in the emergency department (ED), compared with placebo, reduces the likelihood of vomiting and the need for intravenous rehydration.4 This seminal trial changed the standard of ED care for children with gastroenteritis but evidence was lacking for its use in primary care. In this issue of the BJGP , Bonvanie et al report an important pragmatic RCT evaluating the addition of oral ondansetron to usual care in children presenting with acute gastroenteritis in the out-of-hours primary care setting.5 The trial was conducted between 2015 and 2018 in three Dutch centres for out-of-hours care, and included children aged between 6 months and 6 years diagnosed with acute gastroenteritis — defined as ≥4 episodes of vomiting in the 24 hours before presenting, including one episode within 4 hours of presentation. Usual care for children included the provision of ORT, either 10 ml/kg or 15 ml/kg for 4 hours based on hydration status along with administration instructions. Children randomised to the intervention group received a single dose of oral ondansetron syrup (0.1 mg/kg). The trial was open label without a placebo arm — participants, parents, GPs, and the research team were not blinded. The primary outcome was the proportion of children …