Antiemetics for Self-limited Acute Gastrointestinal Illness: A Meta-Analysis Brings Up What You Need to Knowby Lewis First MD, MS, Editor in Chief, Pediatrics

When a child presents to you with acute onset of vomiting or diarrhea, do you recommend an anti-emetic? Dothey work or can they make things worse? A new meta-analysis we are releasing this week by Nino-Serna et al(10.1542/peds.2019-3260) evaluated all randomized controlled trials of a variety of agents includingmetoclopramide, ondansetron, domperidone, dexamethasone, dimenhydrinate, alizapride, and granisetron,some or all of which you may not be using in your practice. The authors identified 24 studies that met theirsearch criteria involving over 3,400 children and then combined these in a meta-analysis to see which might bebetter than placebo. Only one agent in this study proved superior to placebo for reducing the need forintravenous hydration or frequency of vomiting episodes, and one was worse than placebo. To find out whichdrug is effective and determine if you should use it more frequently, check out this interesting meta-analysis andsee if the findings stay down with you by influencing the way you practice. Be aware however, that despite thesebeing randomized controlled studied, there are limitations to this type of analysis. The quality of evidence toeven consider using an agent, as well as the need for parent-self report of just how much vomiting occurred pre-and post-use of an anti-emetic, may be worth considering, but does not take away from your ability to stomachthe findings in this meta-analysis in ways that will help you decide how to treat acute emesis pharmacologicallyin a child, should you wish to do that.

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