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T A B L E O F C O N T E N T S HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . . 2 BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Figure 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Figure 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Figure 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Analysis 1.1. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 1 Rate of admission to hospital (during ED stay). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Analysis 1.2. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 2 Rate of admission to hospital (up to 72 hrs following discharge from ED stay) best-worst case scenario. . . . . . . . . . . 49 Analysis 1.3. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 3 Rate of admission to hospital (up to 72 hrs following discharge from ED stay) worst-best case scenario. . . . . . . . . . . 50 Analysis 1.4. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 4 Rate of intravenous rehydration (during ED stay). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Analysis 1.5. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 5 Rate of intravenous rehydration (up to 72 hrs following discharge from the ED stay), best-worst case scenario. . . . . . . . 52 Analysis 1.6. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 6 Rate of intravenous rehydration (up to 72 hrs following discharge from the ED stay), worst-best case scenario. . . . . . . . 53 Analysis 1.7. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 7 Proportion of participants with cessation of vomiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Analysis 1.8. Comparison 1 Oral ondansetron (weight dependent dose) vs placebo, Outcome 8 Revisit rate. . . . 55 ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . . 73 NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. i
[Intervention Review] Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents Zbys Fedorowicz 1 , Vanitha A Jagannath 2 , Ben Carter 3 1 UKCC (Bahrain Branch), Ministry of Health, Bahrain, Awali, Bahrain. 2 Department of Paediatrics, American Mission Hospital, Manama, Bahrain. 3 North Wales Clinical School, Department of Primary Care & Public Health, School of Medicine, Cardiff University, Wrexham, UK Contact address: Zbys Fedorowicz, UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain. zbysfedo@batelco.com.bh. zbysfedorowicz@gmail.com. Editorial group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 9, 2011. Review content assessed as up-to-date: 30 November 2010. Citation: Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD005506. DOI: 10.1002/14651858.CD005506.pub5. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background A B S T R A C T Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children. Objectives To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. Search methods We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conferences.The search was re-run and is up to date as on 20 July 2010. Selection criteria Randomized controlled trials comparing antiemetics with placebo or no treatment, in children and adolescents under the age of 18, for vomiting due to gastroenteritis. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results We included seven trials involving 1,020 participants. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 1
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A P P E N D I C E S Appendix 1. Sea
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48. exp child/ or child$.tw. 49. ex
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or hexadecadrol or hexadrol or loka
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51. (promethazine or Avomine or adg
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W H A T ’ S N E W Last assessed a
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S O U R C E S O F S U P P O R T Int
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