A Cochrane review (abstract , review [Abstract]) included 7 studies with a total of 1 020 subjects aged from 5 months to 12 years. Oral ondansetron reduced the immediate hospital admission rate compared to placebo (RR 0.40, 95% CI 0.19 to 0.83; NNT 17, 95% CI 10 to 100; 3 studies, n=465) but there was no difference between the hospitalization rates at 72 hours after discharge from the emergency department (ED). Oral ondansetron reduced IV rehydration rates both during the ED stay (RR 0.41, 95% CI 0.29 to 0.59; NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, 95% CI 0.42 to 0.76; NNT 6, 95% CI 4 to 13) and increased the proportion of patients with cessation of vomiting (RR 1.33, 95% CI 1.19 to 1.49; NNT 5, 95% CI 3 to 7). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies.
In one study the proportion of patients with cessation of vomiting in 24 hours was 58% with IV ondansetron, 17% placebo and 33% in the metoclopramide group (P value = 0.039). Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P = 0.036)..
Comment: The quality of evidence is downgraded by study limitations.
Primary/Secondary Keywords