Evaluation of Polyethylene Glycol Dosing for Functional Constipation in Children

Area of Science:

• Pediatric Gastroenterology
• Pharmacology
• Clinical Practice Evaluation

Background:

• Functional constipation is a common pediatric gastrointestinal issue.
• Polyethylene glycol (PEG) is a widely used osmotic laxative for constipation management in children.
• Standardized dosing protocols for PEG in pediatric home cleanouts and maintenance are essential for effective treatment.

Purpose of the Study:

• To evaluate current polyethylene glycol (PEG) dosing practices in a pediatric gastroenterology outpatient setting.
• To determine weight-based PEG dosing schedules for home cleanouts and maintenance therapy.
• To assess the efficacy of prescribed PEG dosing regimens for home cleanouts.

Main Methods:

• Retrospective cohort analysis of electronic medical records from September 2017 to October 2018.
• Inclusion criteria: Patients aged 13 months to 18 years prescribed PEG for functional or slow transit constipation.
• Analysis of cleanout success based on prescriber documentation or documented clear flow; comparison of 1-day versus 2-day cleanout regimens.

Main Results:

• 112 of 201 new patients (55.7%) received a home cleanout recommendation, with 111 (99%) treated with PEG.
• Median weight-based PEG doses for 1-day and 2-day cleanouts were 5.3 ± 2.4 g/kg/day and 4.6 ± 1.9 g/kg/day, respectively.
• Cleanout success rate was 73.7% (28/38); no statistically significant differences in success were found based on PEG dose, cumulative exposure, or cleanout duration.

Conclusions:

• While 1-day PEG cleanout doses align with NASPGHAN best practices, 2-day cleanouts used over double the weight-based doses.
• Doses for 2-day cleanouts were nearly triple those recommended for functional constipation home management.
• Further research is needed to ascertain if these higher doses are necessary for successful management of pediatric functional constipation.