Zofran for PEDIATRIC gastroenteritis

Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. Pediatric acute gastroenteritis has always been a major cause of emergency department (ED) visits and hospitalizations. Pediatric complaints of vomiting and diarrhea have been on the rise, whether it be secondary to the new Omicron-variant of COVID-19, or norovirus and rotavirus which traditionally account for nearly 60% of all cases.

The goals of acute gastroenteritis treatment include preventing dehydration, treating dehydration when it occurs, and reducing duration and severity of symptoms. Guidelines are consistent in recommending that children with dehydration be rehydrated, breast-feeding should be continued, and that an age-appropriate diet be started after initial rehydration (it is not necessary to avoid milk-based products).

• For MILD dehydration ㅡ World Health Organization (WHO) recommends giving children younger than two years 50 to 100 mL of fluid and children two to 10 years of age 100 to 200 mL of fluid; older children may have as much fluid as they want. Children may consume up to 20 mL per kg of body weight per hour.
• For MODERATE dehydration ㅡ Treatment includes an ORS plus medication if needed to decrease vomiting and improve tolerance of the ORS.

Hospital admission is indicated for severe dehydration. Evidence-based guidelines agree that antidiarrheal medications should not be used, but some guidelines recommend the antiemetic ondansetron (Zofran, Danset) as an option to improve success rates of oral rehydration. Giving ondansteron (Zofran) 4 mg for children 4-11 years old weighing greater than 40 kg, and up to 8 mg for those older may be useful. Zofran prescription at discharge was associated with reduced rate of return at 72-hours and was not associated with masking alternative diagnosis like appendicitis and intussusception.

NPS-adv

Table (1)

IV rehydration therapy for severe dehydration in children.

Oral rehydration therapy (ORT) consisting of a low osmolarity solution containing sugar and salts along with zinc has also been shown to optimize treatment and diminish return visits. ORT is available in commercial packets, pre-mixed solutions, or can be made at home with table salt and sugar.

OUR Recommendation

Consider providing a prescription of Zofran along with recommendations for oral rehydration therapy consisting of a low osmolarity solution containing sugar and salts to prevent outpatient treatment failure and return visits.

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References

1. Benary D, Lozano JM, Higley R, Lowe D. Ondansetron Prescription Is Associated With Reduced Return Visits to the Pediatric Emergency Department for Children With Gastroenteritis. Ann Emerg Med. 2020 Nov;76(5):625-634.
2. Hartman S, Brown E, Loomis E, Russell HA. Gastroenteritis in Children. Am Fam Physician. 2019 Feb 1;99(3):159-165.
3. Rivera-Dominguez G, Ward R. Pediatric Gastroenteritis. 2021 Apr 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29763114. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499939.

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