Drug treatment of adults with nausea and vomiting in primary care
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4714 (Published 07 August 2014) Cite this as: BMJ 2014;349:g4714
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I agree with Dr Green that in the case of mild gastroenteritis, explanation, education and reassurance is probably more appropriate than drug treatment considering no proven benefit of drugs, and possibility of harm from side effects. Although the case described was hypothetical, I agree with the comments about expectations.
Competing interests: No competing interests
Correct drug treatment is often no drug treatment.
This young man has presented very early to his GP with mild gastroenteritis symptoms, a condition likely to be in the process of resolution at the time of consultation. The priority should therefore be education rather than symptom relief, encouraging self-care or care with advice from community pharmacy for future episodes. It would have been interesting to know what treatment his girlfriend had had, and what the course of her illness was, as treatment of family members is a powerful driver of expectations.
The provision of an antiemetic, particularly if given by injection, validates the consultation and encourages future early attendance in a way that clinical assessment and explanation does not.
Finally, the provision of a certificate for absence from work for illnesses of less that 7 days is not required in the UK.
Competing interests: No competing interests
I wonder if there is any efficacy data for buccastem, ie oromucosal prochlorperazine, which is very commonly used in UK?
Competing interests: No competing interests
Author's reply - Re: Drug treatment of adults with nausea and vomiting in primary care
Dr Usher, I am not aware of any efficacy trials, but the role of this route of administration certainly warrants further investigation in the primary care setting.
Competing interests: No competing interests