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Topics - Vomito e diarrea

Dehydration and Oral Rehydration

Dehydration means that the body has lost too much fluid. Dehydration can be caused by not drinking enough fluids, vomiting, or diarrhea. Infants and small children are more likely to become dehydrated than adolescents and adults because they can lose fluid quickly. If dehydration becomes severe it can be serious and life-threatening. Luckily, there are many things parents can do to help prevent these serious complications .[Full Article]

Dehydration and Oral Rehydration - Arch Pediatr Adolesc Med. 2010;164(8):784. doi:10.1001/archpediatrics.2010.140
Megan A. Moreno, MD, MSEd, MPH, Writer; Fred Furtner, Illustrator; Frederick P. Rivara, MD, MPH, Editor



The applicability and efficacy of guidelines for the management of acute gastroenteritis in outpatient children: a field-randomized trial on primary care pediatricians.

Objective: To evaluate the applicability and efficacy of guidelines for the management of acute gastroenteritis (AGE) as used by pediatricians.
Study design: This was a national, open, randomized, controlled intervention trial. The intervention consisted of a 2-hour course based on the guidelines for management of AGE. Seventy-five randomly selected primary care pediatricians underwent training in AGE management (group A), and 75 pediatricians who were not specifically trained served as controls (group B). Each pediatrician enrolled 10 children age 1-36 months with acute-onset diarrhea. Outcome measures were guidelines applicability, duration of diarrhea, and difference in body weight between the first visit and 5-7 days later.
Results: The baseline features of the children were similar in groups A (n = 617) and B (n = 692). A total of 404 of the 617 children in group A (65.5%) were fully treated according to the guidelines, compared with 20 of the 692 children in group B (3%). Most violations involved administration of unnecessary drugs or diets. The duration of diarrhea was shorter in group A (intention-to-treat: 83.3 vs 90.9 hours; P < .001). Weight gain was marginally, but statistically significantly, higher in the children treated according to the guidelines (per-protocol analysis: +16.5 gr vs -13.5 gr; P < .05).
Conclusions: Guidelines for AGE have good applicability and excellent efficacy. Adjunctive medical interventions are associated with a longer duration of diarrhea. Copyright 2010 Mosby, Inc. All rights reserved.

The applicability and efficacy of guidelines for the management of acute gastroenteritis in outpatient children: a field-randomized trial on primary care pediatricians. - J Pediatr. 2010 Feb;156(2):226-30. Epub 2009 Oct 15.
Albano F, Lo Vecchio A, Guarino A.
Department of Pediatrics, University of Naples Federico II



Clinical trial: Oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children - a double-blind randomised study.

Summary Background: Vomiting due to gastroenteritis frequently occurs in children. It is still debatable whether vomiting should be treated with antiemetic drugs. Aim: to investigate potential beneficial effects of ondansetron in treating vomiting during acute gastroenteritis.
Methods: A randomized, double blind, placebo-controlled trial was performed in our emergency departments. Children, aged 5 months to 8 years, were randomized to receive either ondansetron tablets or placebo. The primary outcome measure was the frequency of emesis during an 8 hour-period after enrollment.
Results: A hundred and nine patients were enrolled; 54 received placebo and 55 received ondansetron. As compared with the children who received placebo, children who received ondansetron were less likely to vomit both during the first 8 hour follow-up in the emergency department [relative risk (RR): 0.33, 95% CI: 0.19-0.56, NNT: 2, 95% CI: 1.6-3.5], and during the next 24 hours follow-up (RR: 0.15, 95% CI: 0.07-0.33, NNT: 2, 95% CI: 1.3-2.1).
Conclusion: Ondansetron may be an effective and efficient treatment that reduces the incidence of vomiting from gastroenteritis during both the first 8 hours and the next 24 hours, and is probably a useful adjunct to oral rehydration.

Clinical trial: Oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children - a double-blind randomised study - Aliment Pharmacol Ther. 2009 Sep 16. [Epub ahead of print]
Yilmaz HL, Yildizdas RD, Sertdemir Y.
Medical School of Cukurova University, Department of Pediatric Emergency Medicine, Adana, TURKEY.



Diarrhoea and vomiting caused by gastroenteritis
Diagnosis, assessment and management in children younger than 5 years caused by gastroenteritis

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.
The symptoms of gastroenteritis are unpleasant and the illness has an impact on both child and family. Vomiting causes distress and anxiety. Diarrhoea is often accompanied by abdominal pain. Infants and young children with severe symptoms may quickly become dehydrated. Dehydration is a serious and potentially life-threatening condition.
The management of young children with gastroenteritis involves many considerations. Depending on the specific circumstances, care may be provided by parents or by a range of healthcare professionals. Children may be managed in a community or a hospital setting. There is debate and controversy regarding various aspects of clinical management. Clinical practice may have a major impact on the use of healthcare resources. Finally, there is evidence of considerable variation in practice in the management of children with gastroenteritis in the UK. It was for these reasons that this NICE clinical guideline on the management of acute diarrhoea and vomiting due to gastroenteritis in children under 5' was developed.

Diarrhoea and vomiting caused by gastroenteritis. Diagnosis, assessment and management in children younger than 5 years caused by gastroenteritis
National Institute for Health and Clinical Excellence




Antiemetic medications in children with presumed infectious gastroenteritis-- pharmacoepidemiology in Europe and Northern America.

OBJECTIVE: To investigate the prescription pattern of antiemetic medications in 0- to 9-year-old children with infectious gastroenteritis in several industrialized countries during 2005. STUDY DESIGN: We retrospectively retrieved data from 4 national and international databases (IMS MIDAS, IMS disease analyzer, WIdO databases).
RESULTS: Between 2% and 23% of children with gastroenteritis (International Classification of Diseases code A08.X or A09) received prescriptions for antiemetic medications (United States, 23%; 95% CI, 15-31; Germany, 17%; 95% CI, 15-20; France, 17%; 95% CI, 14-19; Spain, 15%; 95% CI, 10-19; Italy, 11%; 95% CI, 7-16; Canada, 3%; 95% CI, 0-16; United Kingdom, 2%; 95% CI, 1-2). The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment. Ondansetron was used in a minor proportion of antiemetic prescriptions (Germany, Canada, Spain, and Italy, 0%; United States, 3%; United Kingdom, 6%).
CONCLUSION: Antiemetic drugs are frequently used in children with gastroenteritis. In different industrialized countries, prescription of antiemetic medication varies considerably. Ondansetron, the only drug with evidence-based antiemetic efficacy, plays a minor role among antiemetic prescriptions.

Antiemetic medications in children with presumed infectious gastroenteritis-- pharmacoepidemiology in Europe and Northern America.
Pfeil N., Uhlig U., Kostev K., Carius R., Schröder H., Kiess W., Uhlig HH.
University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.




Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis to determine whether taking antiemetic drugs reduces vomiting and decreases the need for further intervention in children with gastroenteritis without causing significant adverse effects.
DATA SOURCES: Computerized databases, reference lists, and expert recommendations.
STUDY SELECTION: Prospective controlled trials evaluating medication use in children with vomiting from gastroenteritis.
INTERVENTION: Antiemetic drug therapy.
MAIN OUTCOME MEASURES: Emesis cessation, use of intravenous fluid for rehydration, hospital admission, return to care, and medication adverse effects.
RESULTS: The 11 articles that met the inclusion criteria evaluated various antiemetic agents: ondansetron (n = 6), domperidone (n = 2), trimethobenzamide (n = 2), pyrilamine- pentobarbital (n = 2), metoclopramide (n = 2), dexamethasone (n = 1), and promethazine (n = 1). Meta-analysis of 6 randomized, double-masked, placebo-controlled trials of ondansetron demonstrated decreased risk of further vomiting (5 studies; relative risk [RR], 0.45; 95% confidence interval [CI], 0.33-0.62; number needed to treat [NNT] = 5), reduced need for intravenous fluid (4 studies; RR, 0.41; 95% CI, 0.28-0.62; NNT = 5), and decreased risk of immediate hospital admission (5 studies; RR, 0.52; 95% CI, 0.27-0.95; NNT = 14). Diarrheal episodes increased in ondansetron-treated patients in 3 studies. Ondansetron use did not significantly affect return to care (5 studies; RR, 1.34; 95% CI, 0.77- 2.35).
CONCLUSIONS: Ondansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis. Future treatment guidelines should incorporate ondansetron therapy for select children with gastroenteritis.

Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis
DeCamp LR., Byerley JS., Doshi N., Steiner MJ.
Pediatric Education Office, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine,




Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects.
The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents
Alhashimi D., Al-Hashimi H., Fedorowicz Z.

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Il trattamento farmacologico del vomito in età pediatrica.
Bilancio tra rischi e benefici

Attraverso la Rete Nazionale di Farmacovigilanza sono pervenute diverse segnalazioni di reazioni avverse a farmaci antiemetici nei bambini, in particolare a domperidone e metoclopramide. Il Gruppo di esperti sui farmaci pediatrici dell’AIFA ha effettuato una revisione dei dati di efficacia e sicurezza dei farmaci antivomito nei bambini, al fine di fornire raccomandazioni per la pratica clinica...

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An overview of the clinical use of ondansetron in preschool age children

ABSTRACT
The introduction of 5-HT3 receptor antagonist has revolutionized the prevention and treatment of nausea and vomiting in preschool aged children. These distressing symptoms, arising from multiple etiologies such as anesthesia, chemotherapy, and viral infection, are a major concern of patients and their families. Clinical research has demonstrated the antiemetic effectiveness of ondansetron in children. Although most of these studies focus primarily on preventing vomiting across the pediatric age group, they provide strong evidence for the use of ondansetron in preschool age children. For children at high risk, pediatric practice guidelines recommend ondansetron in conjunction with other antiemetics to achieve complete control of symptoms.

An overview of the clinical use of ondansetron in preschool age children
Ira Todd Cohen
Ther Clin Risk Manag. 2007 June; 3(2): 333–339.


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