The effect of antiemetics in childhood gastroenteritis

Jai K Das, Rohail Kumar, Rehana A Salam, Stephen Freedman, Zulfiqar A Bhutta, Jai K Das, Rohail Kumar, Rehana A Salam, Stephen Freedman, Zulfiqar A Bhutta

Abstract

Introduction: Diarrheal diseases are the second leading cause of childhood morbidity and mortality in developing countries and an important cause of malnutrition. An estimated 0.75 million children below 5 years of age die from diarrhea. Vomiting associated with acute gastroenteritis (AGE) is a distressing symptom and limits the success of oral rehydration in AGE leading to an increased use of intravenous rehydration, prolonged emergency department stay and hospitalization. In this review we estimate the effect of antiemetics in gastroenteritis in children.

Methods: We conducted a systematic review of all the efficacy and effectiveness studies. We used a standardized abstraction and grading format and performed meta-analyses for all outcomes with more than two studies. The estimated effect of antiemetics was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.

Results: We included seven studies in the review. Antiemetics significantly reduced the incidence of vomiting and hospitalization by 54%. Antiemetics also significantly reduced the intravenous fluid requirements by 60%, while it had a non-significant effect on the ORT tolerance and revisit rates.

Conclusion: Antiemetics are effective for the management of gastroenteritis in children and have the potential to decrease morbidity and mortality burden due to diarrhea, when introduced and scaled up.

Figures

Figure 1
Figure 1
Search strategy flow diagram
Figure 2
Figure 2
Forest Plot for the effect of antiemetics for the treatment of gastroenteritis on incidence of vomiting
Figure 3
Figure 3
Forest Plot for the effect of antiemetics for the treatment of gastroenteritis on hospitalizations during ED stay
Figure 4
Figure 4
Application of standardized rules for choice of final outcome to estimate effect of antiemetics in gastroenteritis

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