Zofran use in gastroenteritis
Short: Double-blinded, randomized superiority trial of 1030 kids with gastroenteritis, showed that if patients received Zofran to take at home as needed, they did better than control group.
Long: We all know how effective ondansetron is in treating kids with AGI, but there actually isn’t a lot of data to support its use, but this study gave us some. 6 pediatric emergency
departments in Canada, as part of the Pediatric Emergency Research Canada (PERC, the PECARN of the frozen north), set up a randomized superiority trial looking at the use of PRN
ondansetron after discharge for AGI patients versus placebo in children from 6 months to 18 years. These kids had to have vomiting and diarrhea, with at least 3 episodes of emesis with 1
episode within 6 hours of evaluation, without any other problems. They all got a dose of ondansetron in the ED, were discharged home with 6 more doses of either liquid ondansetron
or liquid placebo (they couldn’t figure out how to do an ODT placebo) and told to take every 8 hours as needed for the next 48 hours. Follow up surveys were sent out to each group at 24
hours, 48 hours, and 7 days, and this is what they found:
- As the primary outcome, they looked at the Vesikari scale over the 7 days after treatment (a scale of AGI severity), and showed that 5.1% of kids who got Zofran scored in the severe category, whereas 12.5% of the placebo group scored in the severe category.
- Continued vomiting occurred in 29.7% of the treatment group and 33.2% of the placebo group.
- Repeat healthcare visits within 7 days were 9.3% in the treatment group and 13.2% in the placebo group.
- There was no increase in diarrhea in the treatment group as compared to the placebo groups. In the few children who received more than 3 doses, there was an increase in diarrhea. Ondansetron has been shown to prolong or increase diarrhea in other studies.
- Parents were equally satisfied with treatment in both groups.
- There were few and equal number of adverse events in both groups.
Takeaways: There were modest improvements overall with PRN Zofran use after discharge, with significant improvements in severity scoring of gastroenteritis overall. This study validates
our prescribing of PRN Zofran for acute AGI.
Long: We all know how effective ondansetron is in treating kids with AGI, but there actually isn’t a lot of data to support its use, but this study gave us some. 6 pediatric emergency
departments in Canada, as part of the Pediatric Emergency Research Canada (PERC, the PECARN of the frozen north), set up a randomized superiority trial looking at the use of PRN
ondansetron after discharge for AGI patients versus placebo in children from 6 months to 18 years. These kids had to have vomiting and diarrhea, with at least 3 episodes of emesis with 1
episode within 6 hours of evaluation, without any other problems. They all got a dose of ondansetron in the ED, were discharged home with 6 more doses of either liquid ondansetron
or liquid placebo (they couldn’t figure out how to do an ODT placebo) and told to take every 8 hours as needed for the next 48 hours. Follow up surveys were sent out to each group at 24
hours, 48 hours, and 7 days, and this is what they found:
- As the primary outcome, they looked at the Vesikari scale over the 7 days after treatment (a scale of AGI severity), and showed that 5.1% of kids who got Zofran scored in the severe category, whereas 12.5% of the placebo group scored in the severe category.
- Continued vomiting occurred in 29.7% of the treatment group and 33.2% of the placebo group.
- Repeat healthcare visits within 7 days were 9.3% in the treatment group and 13.2% in the placebo group.
- There was no increase in diarrhea in the treatment group as compared to the placebo groups. In the few children who received more than 3 doses, there was an increase in diarrhea. Ondansetron has been shown to prolong or increase diarrhea in other studies.
- Parents were equally satisfied with treatment in both groups.
- There were few and equal number of adverse events in both groups.
Takeaways: There were modest improvements overall with PRN Zofran use after discharge, with significant improvements in severity scoring of gastroenteritis overall. This study validates
our prescribing of PRN Zofran for acute AGI.
