Effect Of Ondansetron On Vomiting Associated With Acute Gastroenteritis In A Developing Country: A Meta-analysis

Aim: In high-income countries.ondansetron is an effective antiemetic in children with acute gastroenteritis,but data from low-and middleincome countries are sparse.This study aimed to evaluate evidences of the effectiveness of ondansetron in preventing vomiting and reducing the use of intravenous fluids in children with acute gastroenteritis in developing countries.Methods: Medline,EMBASE,and the Cochrane Library databases were searched for relevant studies and statistical analysis was performed.Results: A total of nine randomized controlled trials(RCTs)involving2313 participants met the inclusion criteria.Compared with placebo,ondansetron increased the chance for vomiting cessation up to the first dose[Two RCTs,n=135,relative risk(RR)3.30,confidence interval(CI)2.11 to 5.16,no heterogeneity,I~2= 0],4h(Three RCTs,n = 1249,RR 1.17,95% CI 1.05–1.30,high heterogeneity,I~2= 64%)and 8 h(One RCT,n=109,RR 2.35,95% CI 1.57 to 3.51)after drug administration,but there was no difference between the groups after 24 and 48 h.Ondansetron reduced the use of intravenous rehydration(Three RCTs,n=1126,RR 0.60,95% CI0.38-0.95,no significant heterogeneity,I~2= 43%),the risk of failure of oral rehydration therapy among children with acute gastroenteritis-associated vomiting and dehydration(Four RCTs,n = 1370,RR 0.58,95% CI 0.43–0.79,no significant heterogeneity was found,I~2=39%),and it had no significant effect on children without dehydration.In addition,ondansetron reduced the risk of hospitalization(Two RCTs,n = 264,RR 0.25,95% CI0.09-0.73,no heterogeneity,I~2=0),but it had no significant effect on the need for return visits to the emergency department.Ondansetron had no significant adverse effects in this study.Conclusion: Compared with placebo,ondansetron reduced the use of intravenous fluids in children with acute gastroenteritis and dehydration.It has no effect on children with acute gastroenteritis who do not present with dehydration in developing countries.While ondansetron is effective in controlling vomiting and reducing the rate of hospitalization,there is no evidence that it is effective in reducing the rate of readmission.