Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: a systematic review.
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.
Candy
D
D
Paediatric Gastroenterology Service, Royal West Sussex NHS Trust, Chichester PO19 6SE, UK. david.candy@rws-tr.nhs.uk
Belsey
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005244:Fecal Impaction / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007792:Lactulose / Q000627:therapeutic use; D054368:Laxatives / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D054368:Laxatives; D011092:Polyethylene Glycols; D007792:Lactulose