Alakeel et al Journal of Drug Delivery & Therapeutics. 2021; 11(5-S):13-18 ISSN: 2250-1177 [ 13] CODEN (USA): JDDTAO Available online on 15.10.2021 at http://jddtonline.info Journal of Drug Delivery and Therapeutics Open Access to Pharmaceutical and Medical Research Copyright © 2021 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited Open Access Full Text Article Research Article Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients Yousif S. Alakeel* a, b, c , Meshary F. Almeshary b, c , Mohammed A. Alghamdi a , Rawa M. Faden a a College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia b King Abdullah International Medical Research Center, Riyadh, Saudi Arabia c Clinical Pharmacy Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia Article Info: _________________________________________ Article History: Received 12 August 2021 Reviewed 17 September 2021 Accepted 22 September 2021 Published 15 October 2021 _________________________________________ Cite this article as: Alakeel YS, Almeshary MF, Alghamdi MA, Faden RM, Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients, Journal of Drug Delivery and Therapeutics. 2021; 11(5-S):13-18 DOI: http://dx.doi.org/10.22270/jddt.v11i5-S.5071 _________________________________________ *Address for Correspondence: Yousif S. Alakeel, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 106652, Riyadh 11676, Saudi Arabia ORCID ID: https://orcid.org/0000-0003-1883-1294 Abstract ______________________________________________________________________________________________________ Objective: To investigate and compare the safety and efficacy of the empirical use of Histamine-2-receptor antagonists (H2RAs) and Proton pump inhibitors (PPIs), for the treatment of unspecified nausea and vomiting (NV) in hospitalized children. Methods: The retrospective cohort study was conducted at King Abdulaziz Medical City in Riyadh (KAMC-R) and included pediatric patients ≤14 years who received acid suppression therapy (AST), H2RAs or PPIs, for the treatment of unspecified NV between April 30, 2018, and April 30, 2019. The primary outcome was the complete resolution of NV within three days of AST. The secondary outcomes were the frequency of rescue medication use, the number of vomiting episodes since starting the AST, and the adverse drug reactions (ADRs). Results: Sixty-two patients were included in the study, 25 (40.3%) were in the H2RAs group and 37 (59.7%) in the PPIs group. The mean age was 3.69 ± 4.13 years, with the majority male (64.5%). Overall, 87% (n=54) of the sample had complete resolution of NV within 3 days of the AST therapy with no difference between the H2RAs and PPIs groups (p=0.344). The number of NV episodes from initiating the AST until the complete resolution was similar between the groups. In total, 14 patients (25.9%) required rescue therapy with granisetron, 6 (26.1%) in the H2RAs group compared to 8 (25.8%) in the PPIs group. There was no difference in the number of the required granisetron doses or the incidence of ADRs. Conclusion: Both PPIs and H2RAs were effective and safe for the treatment of unspecified NV in hospitalized pediatric patients. The selection of either agent should be based on other factors. Keywords: Pediatric; Nausea and vomiting; Proton pump inhibitor; Histamine-2-receptor antagonist; Granisetron. INTRODUCTION Nausea and vomiting (NV) are distressing symptoms in hospitalized children. They are frequent symptoms related to a wide range of gastrointestinal (GI) and non-GI disorders. The incidence of NV associated with general surgery in children is more than 40%, almost twice compared to the adult population. 1-4 Receiving chemotherapy is a well- documented risk of NV, estimated to occur in more than 70% of the pediatric population depending on the emetogenicity of the chemotherapy agent used. 5, 6 In addition, conditions that alter gastric emptying, such as hypokalemia and acidosis, or using medications such as nonsteroidal anti- inflammatory drugs, opioids, antibiotics, and anticholinergics are a frequent cause of NV related to gastropareses. 7, 8 Several pharmacological agents are available to treat NV in children. Acid suppressive therapy (AST), such as Histamin- 2-receptor antagonists (H2RAs), and Proton pump inhibitors (PPIs) are used empirically to treat unspecified NV. In addition to these agents, the 5-HT3 antagonists, such as granisetron, are used as rescue therapy. PPIs are ASTs with the potential of antiemetic properties, as they act on a receptor of the parietal cell on the gastric wall which plays a role in the sensation of nausea by mediating input via the vagal nerve to the nausea-vomiting center in the midbrain. 9 Premedication with PPIs reduces the overall incidence of vomiting post-anesthesia and lowers the total amount of vomit compared to a placebo. 10, 11 They are also successful in maintaining the gastric pH > 4, without adverse effects or significant drug interactions. 12 H2RAs also have the properties to treat GI symptoms by decreasing the production of gastric acids that increases the pH of the gastric content and improves symptoms. 13, 14 Both PPIs and H2RAs are effective in lowering the gastric pH and treating NV associated with different pediatric disease states, including gastrointestinal reflux disease (GERD). 13, 15, 16 However, using AST for acid-non-related NV is controversial. 17, 18 The current study aimed to investigate and compare the safety and efficacy of the empirical use of PPIs and H2RAs for the treatment of unspecified NV in hospitalized pediatric patients.