A recent randomized multicenter study (D Jarzebicka et al. JPGN 2019; 68: 318-24) compared polyethylene glycol 3350 (PEG, aka Miralax) and lactulose for functional constipation in a cohort of 102 patients (12 weeks of treatment and 4 weeks of follow-up).

Dosing:

• PEG 3350 dosing divided into 2 doses:
  • <8 kg:  5 g/day
  • 8-12 kg: 10 g/day
  • 12-20 kg: 15 g/day
  • >20 kg: 20 g/day
• Lactulose was given as 1 mL/kg twice a day

A “good clinical outcome” was considered if there were three or more stools per week and an improvement in stool consistency of at least 2 types in the Bristol scale.

Key findings:

• At week 12, a good clinical outcome was noted in 98% of PEG group compared with 90% in the lactulose group
• PEG group had increased defecations relative to lactulose: 7.9 vs. 5.7, less stool retention: 7% vs 10%, and fewer hard stools 7% vs 13%
• Side effects, mainly abdominal pain and bloating, were reported more frequently with lactulose than with PEG: 23 vs 15, P=0.02)

My take: This study showed that PEG 3350 was more effective and had fewer side effects than lactulose for constipation in children between 6 months of age and 6 years.

Related blog posts:

• Expert 2017 Opinion: Miralax is (Still) First Choice Laxative in Children
• PEG 3350 is Not Associated with Elevated Glycol Levels
• Low Adherence Rate with Polyethylene Glycol
• Here we go again…Mirialax Safety
• Miralax -More Scrutiny, Research Study
• Updated Pediatric Expert Constipation Guidelines
• Miralax Safety | gutsandgrowth
• Data Supporting Miralax | gutsandgrowth

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