scholarly journals LO80: Ondansetron administration to non-dehydrated children with acute gastroenteritis-associated vomiting, in emergency departments in Pakistan: a randomized, blinded, phase 3, superiority trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
S. Freedman ◽  
S. Soofi ◽  
A. Willan ◽  
S. Williamson-Urquhart ◽  
N. Ali ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Therapy ◽  
Fluid Administration ◽  
Double Blind ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Intravenous Fluid Administration ◽  
Superiority Trial ◽  
Randomization Scheme

Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.

scholarly journals 118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Naveen Poonai ◽  
Elizabeth C Powell ◽  
David Schnadower ◽  
Charlie Casper ◽  
Cindy Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Knowledge Translation Strategies

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported >3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P<0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P<0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P<0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P<0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

scholarly journals An epidemic of cholera due toVibrio choleraeO139 in Dhaka, Bangladesh: clinical and epidemiological features

1994 ◽  
Vol 112 (3) ◽  
pp. 463-471 ◽  
Author(s):  
D. Mahalanabis ◽  
A. S. G. Faruque ◽  
M. J. Albert ◽  
M. A. Salam ◽  
S. S. Hoque
Keyword(s):  
Oral Rehydration Therapy ◽  
Watery Diarrhoea ◽  
Large Hospital ◽  
Oral Rehydration ◽  
Hygiene Practices ◽  
Disease Spectrum ◽  
Intravenous Rehydration ◽  
Epidemiological Features ◽  
History Of ◽  
Culture Positive

SUMMARYWe describe the disease spectrum and socio-demographic and epidemiological features of an epidemic of cholera due to a new pathogen.Vibrio choleraeO139, in patients attending a very large hospital in the metropolitan city of Dhaka, Bangladesh.This hospital treats 70000–90000 patients a year with diarrhoeal diseases. A 4% systematic sample of 1854 patients attending from January to April 1993 were studied.Five hundred and two (27%) of the 1854 patients were culture positive forV. choleraeO139 and 63 (3%) were culture positive forV. choleraeO1 biotype El Tor. Patients withV. choleraeO139 were mainly adults with a short history of watery diarrhoea. Eight-three percent of patients had moderate to severe dehydration. All recovered except one 80-year-old man with compromised renal function who died. Seventy-eight percent of patients required initial intravenous rehydration followed by oral rehydration therapy with rice ORS; they also received tetracycline to reduce diarrhoea severity. Most patients were from urban slums with inadequate sanitation facilities and hygiene practices.The newly recognizedV. choleraeO139 infection produced an epidemic of severe dehydrating diarrhoea indistinguishable from clinical cholera in a population which experiences two epidemic peaks of cholera in a year due toV. choleraeO1. Infection with the latter does not appear to confer any cross-protection fromV. choleraeO139. The new pathogen suppressed, albeit temporarily,V. choleraeO1. Unlike other non-O1 serogroups ofV. choleraethis new serogroup appears to have epidemic potential.

scholarly journals An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

2021 ◽  
Vol 4 (1) ◽  
pp. 023-026
Author(s):  
D’Sa Saskia ◽  
Hussain Ahad ◽  
Hussain Mushtaq ◽  
Afridi Zahir ◽  
Twomey John ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Oral Intake ◽  
Admission Rate ◽  
Cost Effective ◽  
Oral Rehydration Therapy ◽  
University Hospital ◽  
Oral Hydration ◽  
Effective Measure ◽  
Oral Rehydration ◽  
Admission Rates

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.

scholarly journals LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
N. Poonai ◽  
E. Powell ◽  
D. Schnadower ◽  
T. Casper ◽  
C. Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
A Priori ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Knowledge Translation Strategies

Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua

PEDIATRICS ◽  
1994 ◽  
Vol 93 (5) ◽  
pp. 719-725 ◽  
Author(s):  
Jennifer Jacobs ◽  
Stephen S. Gloyd ◽  
James L. Gale ◽  
L. Margarita Jiménez ◽  
Dean Crothers
Keyword(s):  
Clinical Trial ◽  
Treatment Group ◽  
Acute Diarrhea ◽  
Childhood Diarrhea ◽  
Double Blind ◽  
Oral Rehydration ◽  
Homeopathic Treatment ◽  
Homeopathic Medicine ◽  
Double Blind Clinical Trial ◽  
Significant Difference

Objective. Acute diarrhea is the leading cause of pediatric morbidity and mortality worldwide. Oral rehydration treatment can prevent death from dehydration, but does not reduce the duration of individual episodes. Homeopathic treatment for acute diarrhea is used in many parts of the world. This study was performed to determine whether homeopathy is useful in the treatment of acute childhood diarrhea. Methodology. A randomized double-blind clinical trial comparing homeopathic medicine with placebo in the treatment of acute childhood diarrhea was conducted in León, Nicaragua, in July 1991. Eighty-one children aged 6 months to 5 years of age were included in the study. An individualized homeopathic medicine was prescribed for each child and daily follow-up was performed for 5 days. Standard treatment with oral rehydration treatment was also given. Results. The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P < .05) in the number of stools per day between the two groups after 72 hours of treatment. Conclusions. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.

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