Dupuis, L.L., Boodhan, S., Holdsworth, M., Robinson, P.D., Hain, R., Portwine, C., ... Sung, L. (2013). Guideline for the prevention of acute nausea and vomiting due to antineoplastic medication in pediatric cancer patients. Pediatric Blood & Cancer, 60(7), 1073–1082. 

DOI Link

Purpose & Patient Population

PURPOSE: To summarize evidence and provide antiemetic recommendations for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) among children receiving chemotherapy
 
TYPES OF PATIENTS ADDRESSED: Pediatric oncology patients receiving chemotherapy

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline  
 
PROCESS OF DEVELOPMENT: Articles were identified through a search of databases and independently reviewed and scored by three to four members of the Guideline Development Panel using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Evidence summary tables were compiled and reviewed by two panel members before an article was considered for inclusion in a meta-analysis completed by the panel.     
 
DATABASES USED: Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR), Allied and Complementary Medicine (AMED), Health Technology Assessment (HTA), National Health Service Economic Evaluation Database (NHS EED), EBSCOhost, and Google
 
KEYWORDS: N/A
 
INCLUSION CRITERIA: Full-text articles published in English or French reporting pediatric data separately, reporting emetogenicity of the chemotherapy used, providing an explicit or implicit definition of complete acute antineoplastic-induced nausea and vomiting (AINV) response, and reporting the complete acute AINV response rate as a proportion or percentage
 
EXCLUSION CRITERIA: Articles only available as abstracts.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Pediatrics 

Results Provided in the Reference

Table of antiemetic recommendations and strength of evidence of recommendations

Guidelines & Recommendations

Antiemetic therapies with a “strong” recommendation: 
  1. Children ≥ 12 years, high emetogenicity, no known interaction with aprepitant-ondansetron or granisetron and dexamethasone and aprepitant, if interaction with aprepitant–ondansetron or granisetron and dexamethasone 
  2. Children < 12 years, high emetogenicity: Ondansetron or granisetron and dexamethasone
  3. No age restriction, moderate emetogenicity: Ondansetron or granisetron and dexamethasone
  4. No age restriction, low emetogenicity: Ondansetron or granisetron
  5. No age restriction,  minimal emetogenic risk: No routine prophylaxis
  6. Aprepitant should be restricted to children 12 years of age and older who are about to receive highly emetogenic chemotherapy, which is not known to interact with aprepitant. There is no evidence to support the safe and effective use of aprepitant in younger children.
  7. Aprepitant dose recommendations: Day 1, 125 mg PO x 1; Days 2 and 3, 80 mg PO once daily
  8. Chlorpromazine dose recommendations: 0.5 mg/kg/dose IV q6h
  9. Dexamethasone dose recommendations: ≤ 0.6 m2, 2 mg/dose IV/PO q12h; > 0.6 m2, 4 mg/dose IV/PO q12h. If given concurrently with aprepitant, reduce dexamethasone dose by half. 
  10. Granisetron dose recommendations: High emetogenicity, 40 mcg/kg/dose IV as a single daily dose; moderate emetogenicity, 40 mcg/kg/dose IV as a single daily dose; low emetogenicity, 40 mcg/kg/dose IV as a single daily dose 
  11. Metoclopramide dose recommendations: Moderate emetogenicity, 1 mg/kg/dose IV pretherapy x 1 and then 0.0375 mg/kg/dose PO q6h. Give diphenhydramine or benztropine concurrently. 
  12. Ondansetron dose recommendations: High emetogenicity, 5 mg/m2/dose (0.15 mg/kg/dose) IV/PO pretherapy x 1 and then q8h; moderate emetogenicity, 5 mg/m2/dose (0.15 mg/kg/dose, maximum 8 mg/dose) IV/PO pre-therapy x 1 and then q12h; low emetogenicity, 10 mg/m2/dose (0.3 mg/kg/dose, maximum 16 mg/dose IV or 24 mg/dose PO) pretherapy x 1   

Limitations

Limited evidence exists for the prevention of CINV in pediatric populations making conclusions and guidelines difficult to establish.

Nursing Implications

When managing acute CINV in pediatric patients, nurses can make informed decisions by consulting evidence-based guidelines.