Macrogol (polyethylene glycol) based laxatives in children with functional constipation and faecal impaction: A systematic review

Introduction: The evidence base to support the use of laxatives in children is very limited, although previous reviews have suggested that osmotic laxatives may be preferred. Following the publication of a number of new studies involving macrogols, we undertook an updated systematic review to clarify the issue. Method: 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, with primary chronic constipation. Outcomes were assessed as either global assessments of effectiveness or differences in defaecation rates. Results: 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 (2 studies) or superior to (4 studies) active comparator. Differences in study design precluded meaningful meta-analysis. Conclusions: 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.