If anyone knows of a controlled study (double blind would be nice) that shows the addition of phenergan decreases serious morbidity, hospitalization, or death, I would like very much to see it. Without this, I will continue to not use it for vomiting caused by infectious processes. David Tinkelman,MD ------------------ Reply Separator -------------------- Originally From: "Andrew M. Eisen, MD" <> Subject: Re: Alternative routes for meds Date: 02/04/1999 08:38am Dr Ranjit Pandey wrote: > Oral Rehydration is effective and most appropriate in populations where > Gastro-enteritis in children is of epidemic proportions - such as in my > practice in India. Fairly large number of children come with vomiting and we > have successfully treated them with oral pherargan and ORS. It would be very > difficult for us to accommodate all or even 50% for IV fluid therapy. ORS is > effective and most cost effective. > Dr Ranjit Pandey MD.DCH > Paediatrician. > Gwalior India You're on to another issue here, but an important one. There is no question that oral rehydration is the better way to go if it's possible. Here in the US, we're a bit too impatient to try it nearly as often as we should, but we're getting better, and trying it on more kids. We're slowly learning what's been well-known in most of the world for decades. The phenothiazine issue is different. Maybe it's because I see a fair number of kids in the hospital being given parenteral promethazine that I've seen a very high incidence of dystonic reactions. I don't have any data on this, but maybe the slower rise to peak blood levels with enteral administration is somehow protective, making the risk lower in oral or rectal use. Transdermal use could have kinetics at either end of the scale, or anywhere in between. If my completely made up theory is correct, then if TD absorption is slow like PO or PR, then the risk of EPS would be low. If absorption is rapid, then perhaps the risk is high. I'm not saying it's a bad thing, I'm saying I don't know if it is, that it COULD be, and that hydration is the more important treatment anyway. -- Andrew M. Eisen, MD, FAAP Assistant Professor of Pediatrics Associate Director, Pediatric Residency Program University of Nevada School of Medicine ---------------------------------------------------------------------- - group. "http://www.pcc.com/lists/"; "unsubscribe"