A recent review provided an update of nonantibiotic therapies for acute gastroenteritis (AGE), focusing on antiemetics and probiotics. The primary therapy for nonsevere AGE is oral rehydration therapy (ORT). 

Recent randomized controlled trials and meta-analyses have provided evidence-based support in favour of single-dose ondansetron administration in emergency departments to facilitate ORT as it safely reduces intravenous fluid administration and hospitalization rates. However, Intravenous and multiple-dose of ondansetron should be avoided. 

A study reported improved outcomes with the use of bimodal release ondansetron formulation in adolescents as well as in adults with AGE, but it needs further trials. 

Probiotic administration has shown a lack of benefit in the recent large trials and that the guidelines recommending their use should reevaluate their positions according to these findings. Moreover, one must be cautious while using it in high-risk populations and settings.

Thus this review clarifies the benefits, dosing/route, and target populations to be benefitted by the use of ondansetron; and also focused on the importance of the implementation strategies for its optimal use. 

Furthermore, the evidence from the recent high-quality trials suggests a lack of efficacy and potential harm with probiotic use, discouraging its routine use for AGE.

Source: Curr Opin Infect Dis. 2020 Oct;33(5):381-387. doi: 10.1097/QCO.0000000000000670. PMID: 32833690.