Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: a systematic review
- 1Paediatric Gastroenterology Service, Royal West Sussex NHS Trust, Chichester, UK
- 2JB Medical Ltd, The Old Brickworks, Chapel Lane, Little Cornard, Sudbury, UK
- Professor David C A Candy, Royal West Sussex NHS Trust, Chichester PO19 6SE, UK;
- Accepted 9 September 2008
- Published Online First 19 November 2008
As the evidence base supporting the use of laxatives in children is very limited, we undertook an updated systematic review to clarify the issue. A comprehensive literature search was carried out to identify randomised controlled trials of polyethylene glycol (PEG) versus either placebo or active comparator, in patients aged <18 years with primary chronic constipation. Outcomes were assessed as either global assessments of effectiveness or differences in defaecation rates. Seven qualifying studies involving 594 children were identified. Five were comparisons of PEG with lactulose, one with milk of magnesia and one with placebo. Study duration ranged from 2 weeks to 12 months. PEG was significantly more effective than placebo and either equivalent to (two studies) or superior to (four studies) active comparator. Differences in study design precluded meaningful meta-analysis. Lack of high quality studies has meant that the management of childhood constipation has tended to rely on anecdote and empirical treatment choice. Recent publication of well designed randomised trials now permits a more evidence-based approach, with PEG-based treatments having been proven to be effective and well-tolerated first-line treatment.
Funding: This review was sponsored by an unrestricted educational grant from Norgine Pharmaceuticals Ltd.
Competing interests: DC has previously received research and educational grants from Norgine UK Ltd. JB has received consultancy fees for data analysis from Norgine Ltd.