Review in pediatric patient

1. Bolus vs Drip
Which Antiemetic Administration Is Better?
Dwi Ambar Prihatining Utami
FKUI-RSCM

2. Introduction
• Previous study listed vomiting and nausea as the most
severe side effects of cancer chemotherapy *
• Differences between intravenous drip (continous) or bolus
may affect vomitting episodes
• Bolus administratin possibly more convenient for pediatric
patient  clinical outcome?
• Explore which route offer better advantage
*) Cited from Aapro, M. S. (2007). Palonosetron as an anti-emetic and
anti-nausea agent in oncology. Therapeutics and Clinical Risk
Management, 3(6), 1009–1020.

3. Exploring Bolus vs Drip
• Google, google scholar and pubmed search using keywords, such as:
> emetogenic chemotherapy comparison intravenous bolus continuous pediatric
> antiemetic comparison intravenous bolus children
> emesis comparison intravenous bolus children
• Result?  No guideline and study on the issue
• Most study compared different antiemetic agent or different routes
(intravenous vs intra muscular vs oral)

4. • Keywords search were expand to a more general search term:
>emetogenic chemotherapy comparison intravenous bolus continuous
>antiemetic comparison intravenous bolus continuous
• There are few reports in oncology, stem cell transplantation
and thyroidectomy cases, all related to adult patient
Exploring Bolus vs Drip

5. • Safety and efficacy comparison:
▫ Bolus iv granisetron (10 micrograms/kg)
▫ Standard (15-minute) iv ondansetron (32 mg)
• Moderately emetogenic chemotherapy cyclophosphamide plus
doxorubicin, with or without 5-fluorouracil
• Randomized, double-blind, double-dummy, multicenter crossover
study of 623 chemotherapy-naive patients (2 male, 621 female)
receiving moderately emetogenic chemotherapy
RESULT
• Both is similarly effective and and well tolerated
• Ondansentron  greater proportion of abnormal vision.
• Bolus granisetron offer shorter waiting time (between the end of the
antiemetic infusion and the initiation of chemotherapy)
 enhance patient convenience and provider (clinic) efficiency.
Antiemetic Breast Cancer
Source: Perez EA et al. Comparable safety and antiemetic efficacy of a brief (30-
second bolus) intravenous granisetron infusion and a standard (15-minute)
intravenous ondansetron infusion in breast cancer patients receiving
moderately emetogenic chemotherapy. Cancer J Sci Am. 1998; 4(1):52-8.

6. Stem Cell Transplantation
• Double-blind studies in 43 patient for assessing the efficacy and
pharmacokinetics in haematopoietic stem-cell transplantation
• IV bolus granisetron (10 μg/kg bodyweight/day in 24 patient)
versus IV drip (continuous-infusion) granisetron (10 μg/kg
bodyweight infused over 24 hours in 19 patient)
• There is no superiority between both antiemetic administration
(similar pharmacokinetics). There is adverse effect such as headache
and constipation in each study group that is linked to the
medication (not administration)

7. Thyroidectomy
• Randomized 150 female patient with thyroidectomy
• Comparison between:
▫ 2 times : bolus infusion ramosetron 0.15 mg +
continous infusion of ramosetron 0.15 mg)
▫ 0.3 mg ramosetron (single bolus)
• No significant differences

8. Conclusion
• There is no studies of antiemetic safety and efficacy
between intravenous drip (continous) versus bolus in
pediactric oncology case
• Publication in adult breast cancer, stem cell transplant
and thyroidectomy suggest that both mode of
administration offer no significant differences
• A clinical study is required to reach a better
understanding potential research topics for thesis