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Ondansetron and probiotics in the management of pediatric acute gastroenteritis in developed countries

Schnadower, Davida; Finkelstein, Yaronb; Freedman, Stephen B.c

Current Opinion in Gastroenterology: January 2015 - Volume 31 - Issue 1 - p 1–6
doi: 10.1097/MOG.0000000000000132

Purpose of review Acute gastroenteritis (AGE) is a common and impactful disease, typically managed with supportive care. There is considerable interest in the role of adjunctive therapies, particularly ondansetron and probiotics in improving AGE outcomes. The purpose of this review is to present the latest evidence regarding the use of these agents in children with AGE in developed countries.

Recent findings Single-dose oral ondansetron is effective and safe in reducing hospital admissions and the use of intravenous rehydration in children with AGE in emergency-department-based trials. Ondansetron use has increased significantly; however, ‘real-world’ studies of effectiveness have documented less impressive clinical impacts. Similarly, probiotic consumption is growing rapidly. Although several strains appear to reduce the duration of diarrhea in hospitalized children, current data are insufficient to support the routine use of probiotics in outpatient pediatric AGE.

Summary Ondansetron and probiotics may improve patient outcomes in pediatric AGE. Appropriate strategies are needed to optimally integrate oral ondansetron into clinical practice to maximize its potential benefits. Although probiotics remain a promising option, there are challenges in generalizing the data available to patients presenting for outpatient care. Large randomized controlled trials are needed to definitively guide the clinical use of probiotics in outpatients in developed countries.

aDivision of Pediatric Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA

bDivisions of Emergency Medicine and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario

cSections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada

Correspondence to David Schnadower, MD, MPH, Associate Professor of Pediatrics, Fellowship Director, Division of Pediatric Emergency Medicine, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8116, St. Louis, MO 63110, USA. Tel: +1 314 747 5604; fax: +1 314 454 4345; e-mail:

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