Pharmacological management of childhood constipation: Bridging today’s gaps with tomorrow’s therapies

Table 1 Comparison of pharmacological interventions in guidelines

Guideline
Pharmacological agents	NICE (2017)	ESPGHAN/NASPGHAN (2014)	IAP (2018)	Saudi experts (2022)
Osmotic laxatives
High-dose PEG for dis impaction	√	√	√	√
Low-dose PEG for maintenance phase	√	√	√	√
Lactulose for maintenance when PEG is not available	√	√	√	√
Stimulant laxatives as adjunct therapy with PEG during maintenance. e.g. Bisacodyl, Senna, Sodium Picosulfate	√	√	×	√
Enemas for disimpaction when PEG is not available. e.g. Sodium lauryl sulfoacetate, Sodium docusate, Sodium phosphate	√	√	√	×
Lubricants. e.g. Mineral oil, Liquid paraffin	×	√	×	×
Novel agents
Prucalopride	×	×	×	×
Lubiprostone	×	×	×	×
Linaclotide	×	×	×	×

NICE: National Institute for Clinical Excellence UK; ESPGHAN: European Society of Pediatric Gastroenterology, Hepatology and Nutrition; NASPGHAN: North American Society of Pediatric Gastroenterology, Hepatology and Nutrition; IAP: Indian Academy of Pediatrics; PEG: Polyethylene glycol.