Kruger Howard Amy, Morgan Jill A
University of Maryland School of Pharmacy, Baltimore, MD, USA.
Hosp Pharm. 2024 Dec;59(6):645-649. doi: 10.1177/00185787241257390. Epub 2024 Jun 1.
The goal of this study was to evaluate the current use of polyethylene glycol (PEG) in a pediatric gastroenterology outpatient clinic. The primary endpoint was to determine the current weight-based PEG dosing schedules used for home cleanouts and maintenance treatment for functional constipation. The secondary endpoint was to assess the dosing efficacy for home cleanouts. This study was a retrospective cohort analysis of electronic medical records documenting new patient visits at our pediatric gastroenterology clinic between September 2017 and October 2018. Patients included in the study were 13 months to 18 years of age and prescribed PEG for an at-home cleanout and/or maintenance therapy for functional or slow transit constipation. Study participants given a clean-out regimen were divided into those who received treatment for less than 2 days or more. Cleanouts were considered successful if documented as such by the prescriber in the follow-up note or if there was documentation of clear flow. Of the 201 new patients included, 112 (55.7%) received a recommendation for a home cleanout. Of these, 111 patients (99%) underwent PEG-based therapy with or without additional agents. The median weight-based PEG dose was 5.3 ± 2.4 and 4.6 ± 1.9 g/kg/day for 1- and 2-day cleanouts, respectively ( = 0.124). Of the 38 patients with documented outcomes, 28 (73.7%) were successful. We observed no statistically significant differences in the number of successful versus unsuccessful outcomes based on PEG dosing ( = 0.3) or cumulative dose exposures ( = 0.388). Similarly, we observed no significant differences when comparing those on 1-day versus 2-or-more-day cleanouts, ( = 0.17). The median weight-based maintenance PEG dose was 0.74 g/kg/day (interquartile range [IQR], 0.55, 0.96). While the PEG doses used by this clinic for 1-day bowel cleanouts align with the NASPGHAN best practices for colonoscopy report, patients who underwent a 2-day cleanout were provided more than double the weight-based doses. The doses were nearly 3-fold higher than the recommended doses for functional constipation home cleanouts. More information will be needed to determine if these higher doses for home cleanouts are needed for the successful management of patients with functional constipation.
本研究的目的是评估儿科胃肠病门诊中聚乙二醇（PEG）的当前使用情况。主要终点是确定目前用于家庭肠道准备和功能性便秘维持治疗的基于体重的PEG给药方案。次要终点是评估家庭肠道准备的给药效果。本研究是一项回顾性队列分析，分析了2017年9月至2018年10月期间在我们儿科胃肠病诊所记录新患者就诊情况的电子病历。纳入研究的患者年龄在13个月至18岁之间，因功能性或慢传输型便秘而开具PEG用于家庭肠道准备和/或维持治疗。接受肠道准备方案的研究参与者被分为接受治疗少于2天或更多天的两组。如果在随访记录中开具医嘱记录为成功，或者有通畅排便的记录，则认为肠道准备成功。在纳入的201名新患者中，112名（55.7%）接受了家庭肠道准备的建议。其中，111名患者（99%）接受了基于PEG的治疗，无论是否使用了其他药物。1天和2天肠道准备的基于体重的PEG中位剂量分别为5.3±2.4和4.6±1.9 g/kg/天（P=0.124）。在有记录结果的38名患者中，28名（73.7%）成功。基于PEG给药（P=0.3）或累积剂量暴露（P=0.388），我们观察到成功与未成功结果的数量没有统计学上的显著差异。同样，在比较1天与2天或更长时间肠道准备的患者时，我们也没有观察到显著差异（P=0.17）。基于体重的PEG维持中位剂量为0.74 g/kg/天（四分位间距[IQR]，0.55，0.96）。虽然该诊所用于1天肠道准备的PEG剂量与NASPGHAN结肠镜检查最佳实践报告一致，但接受2天肠道准备的患者所接受的基于体重的剂量是其两倍多。这些剂量比功能性便秘家庭肠道准备的推荐剂量高出近3倍。需要更多信息来确定这些更高的家庭肠道准备剂量是否是成功管理功能性便秘患者所必需的。
