Polyethylene Glycols with or without Electrolytes for Constipation in Children: A Network Meta-Analysis

Background: Polyethylene glycol laxatives are the cornerstone of the management of constipation in children. They are available with and without electrolytes.Aims: The aims of this network meta-analysis (NMA) were to assess the relative efficacy, safety and tolerability of polyethylene glycol with (PEG+E) or without electrolytes (PEG) in the management of constipation in children.Methods: A systematic review and NMA was undertaken to identify and analyse all published randomised controlled clinical trials of polyethylene glycol in children with constipation. Text word searches were carried out using MEDLINE, MEDLINE in Progress, EMBASE, Cochrane Database and Systematic Reviews databases covering inception to April 2015. The primary efficacy analysis was the mean number of bowel movements per week. Secondary endpoints assessed safety, tolerability and compliance.Results: 15 studies (involving 1,384 patients) were included in the NMA. PEG and PEG+E are both more effective than placebo, increasing the mean number of bowel movements per week by 2.3 (95% Crl 0.3, 4.4) and 2.2 (95% Crl 0.1, 4.7) respectively. Direct comparison of PEG+E with PEG identified no differences in efficacy, safety, or tolerability, with the exception of one study demonstrating better tolerability with PEG. Compared to PEG+E, PEG was easier to take, with a trend towards improved compliance.Conclusion: This NMA provides no evidence to support the clinical utility of added electrolytes to polyethylene glycol in the management of constipation in children. PEG alone is as effective as PEG+E and both therapies are well tolerated. This analysis supports the ongoing use of polyethylene glycol as a first-line treatment of constipation in children. Formulations without electrolytes should be considered first to optimize patient acceptability and adherence.