Bromopride, metoclopramide, or ondansetron for the treatment of vomiting in the pediatric emergency department: a randomized controlled trial

• Published in: Jornal de pediatria 2018-01, Vol.94 (1), p.62-68
• Main Authors: Epifanio, Matias, Portela, Janete de L., Piva, Jefferson P., Ferreira, Cristina H. Targa, Sarria, Edgar E., Mattiello, Rita
• Format: Article
• Language: English
• Subjects: Acute Disease; Antiemetics; Antiemetics - administration & dosage; Antieméticos; Child; Child, Preschool; Clinical trial; Emergency Service, Hospital; Ensaio clínico; Female; Humans; Infant; Male; Metoclopramide - administration & dosage; Metoclopramide - analogs & derivatives; Ondansetron - administration & dosage; PEDIATRICS; Treatment Outcome; Vomiting; Vomiting - drug therapy; Vômito
• ISSN: 0021-7557; 1678-4782; 1678-4782
• DOI: 10.1016/j.jped.2017.06.004

To compare the effectiveness of a single intramuscular dose of bromopride, metoclopramide, or ondansetron for treating vomiting. Randomized controlled trial including children 1–12 years of age presenting with acute vomiting at the pediatric emergency department. Outcomes: Number of children that stopped vomiting at one, six, and 24h following treatment; episodes of diarrhea; acceptance of oral liquids; intravenous rehydration; return to hospital and side effects. There were 175 children who completed the study. Within the first hour after treatment, all drugs were equally effective, with ondansetron preventing vomiting in 100%, bromopride in 96.6%, and metoclopramide in 94.8% of children (p=0.288). Within six hours, ondansetron was successful in preventing vomiting in 98.3% of children, compared to bromopride and metoclopramide, which were successful in 91.5% and 84.4% of patients, respectively (p=0.023). Within 24h, ondansetron was superior to both other agents, as it remained efficacious in reducing vomiting in 96.6% of children, as opposed to 67.8% and 67.2% with bromopride and metoclopramide, respectively (p=0.001). The ondansetron group showed better acceptance of oral liquids (p=0.05) when compared to the bromopride and metoclopramide. The ondansetron group did not show any side effects in 75.9% of cases, compared to 54.2% and 53.5% in the bromopride and metoclopramide groups, respectively. Somnolence was the most common side effect. A single dose of ondansetron is superior to bromopride and metoclopramide in preventing vomiting six hours and 24h following treatment. Oral fluid intake after receiving medication was statistically better with Ondansetronwhile also having less side effects compared to the other two agents. Para comparar a eficácia de uma única dose intramuscular de bromoprida, metoclopramida ou ondansetrona no tratamento de vômito. Ensaio controlado randomizado incluindo crianças de 1 a 12 anos de idade que apresentam vômito agudo no departamento de emergência pediátrica. Desfechos: Número de crianças que pararam de vomitar 1, 6 e 24 horas após o tratamento; episódios de diarreia; aceitação de líquidos orais; reidratação intravenosa, retorno ao hospital e efeitos colaterais. 175 crianças concluíram o estudo. Na primeira hora após o tratamento, todos os medicamentos foram igualmente eficazes, sendo que a ondansetrona preveniu vômito em 100%, a bromoprida em 96,6% e metoclopramida em 94,8% das crianças (p=0,288). Em 6 horas, a ondansetro