Symptomatic Treatment of Acute Gastroenteritis

• Percentage of patients needing nasogastric or intravenous rehydration after symptomatic oral treatment failure, defined as vomiting or fluid refusal after the second attempt of ORT. [ Time Frame: 6 hours ] [ Designated as safety issue: No ]
  

• Percentage of subjects needing hospital admission for the same illness; [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
  
• Percentage of subjects needing observation stay for more than 6 hours for the same illness [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
  
• Total emesis duration in the 3 allocation groups; [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
  
• Number of episodes of vomiting in the 3 treatment groups during the follow-up period [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
  
• Percentage of subjects presenting adverse events [ Time Frame: 48 hours ] [ Designated as safety issue: Yes ]
  

Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking.

The aim of this multicentre, double-blind randomized controlled trial conducted in paediatric Emergency Departments is to compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed Oral Rehydration Therapy.

The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results