مجال
التميز
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تميز دراسي وبحثي
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البحوث المنشورة
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البحث (1):
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عنوان البحث:
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Systematic review of the toxicity of
short-course oral corticosteroids in children
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رابط إلى البحث:
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Click here
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تاريخ النشر:
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17 March 2016
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موجز عن البحث:
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Background: Short-course oral
corticosteroids are commonly used in children but are known to be associated
with adverse drug reactions (ADRs). This review aimed to identify the most
common and serious ADRs and to determine their relative risk levels.
Methods: A literature search of EMBASE,
MEDLINE, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and
PubMed was performed with no language restrictions to identify studies in
which oral corticosteroids were administered to patients aged 28 days to 18 years
of age for up to and including 14 days of treatment. Each database was
searched from their earliest dates to December 2013. All studies providing
clear information on ADRs were included.
Results: Thirty-eight studies including 22
randomised controlled trials (RCTs) met the inclusion criteria. The studies
involved a total of 3200 children in whom 850 ADRs were reported. The three
most frequent ADRs were vomiting, behavioural changes and sleep disturbance,
with respective incidence rates of 5.4%, 4.7% and 4.3% of patients assessed
for these ADRs. Infection was one of the most serious ADRs; one child died
after contracting varicella zoster. When measured, 144 of 369 patients showed
increased blood pressure; 21 of 75 patients showed weight gain; and biochemical
hypothalamic–pituitary–adrenal axis suppression was detected in 43 of 53
patients.
Conclusions: Vomiting, behavioural changes
and sleep disturbance were the most frequent ADRs seen when short-course oral
corticosteroids were given to children. Increased susceptibility to infection
was the most serious ADR.
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البحث (2):
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عنوان البحث:
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Systematic Review Of
The Toxicity Of Long-Course Oral Corticosteroids In Children
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رابط إلى البحث:
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Click
here
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تاريخ النشر:
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26 January 2017
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موجز عن البحث:
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Background: Long courses of oral corticosteroids are
commonly used in children in the management of chronic conditions. Various
adverse drug reactions (ADRs) are known to occur with their use. This
systematic review aimed to identify the most common and serious ADRs and to
determine their relative risk levels.
Methods: A literature search of Embase, Medline,
International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed
was performed with no language restrictions in order to identify studies
where oral corticosteroids were administered to patients aged 28 days to 18
years of age for at least 15 days of treatment. Each database was searched
from their earliest dates to January 2016. All studies providing clear
information on ADRs were included.
Results: One hundred and one studies including 33
prospective cohort studies; 21 randomised controlled trials; 21 case series
and 26 case reports met the inclusion criteria. These involved 6817 children
and reported 4321 ADRs. The three ADRs experienced by the highest number of
patients were weight gain, growth retardation and Cushingoid features with
respective incidence rates of 21.1%, 18.1% and 19.4% of patients assessed for
these ADRs. 21.5% of patients measured showed decreased bone density and 0.8%
of patients showed osteoporosis. Biochemical HPA axis suppression was
detected in 269 of 487 patients where it was measured. Infection was the most
serious ADR, with twenty one deaths. Varicella zoster was the most frequent
infection (9 deaths).
Conclusions: Weight gain, growth retardation and
Cushingoid features were the most frequent ADRs seen when long-course oral
corticosteroids were given to children. Increased susceptibility to infection
was the most serious ADR.
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المؤتمرات العلمية:
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المؤتمر (1):
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عنوان المؤتمر:
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The Neonatal And Paediatric Pharmacists
Group (NPPG) 20th Annual Conference
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تاريخ الإنعقاد:
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7–9 November 2014
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مكان
الإنعقاد:
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Nottingham, UK
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طبيعة المشاركة:
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Oral presentation
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عنوان المشاركة:
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Short-Course Oral Corticosteroid
Toxicity In Children
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ملخص المشاركة:
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Background: Multiple studies have evaluated
and reported adverse drug reactions (ADRs) of corticosteroids. Short course
oral corticosteroids are commonly used in children in the management of
conditions such as asthma exacerbations. This systematic review aimed to identify
the most common and serious ADRs associated with short courses of oral
corticosteroids and to determine their relative risk levels in children.
Methods: A literature search of several
databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL,
the Cochrane Library and PubMed was performed to identify all studies where
corticosteroids had been administered to paediatric patients ranging from 28
days to 18 years of age for up to and including 14 days of treatment. Each
database was searched from their earliest dates to December 2013. All types
of studies that provided clear information on adverse events were included
with no language restrictions. Quality assessments were performed on all
studies by two independent reviewers.
Results: Thirty eight studies met the
inclusion criteria. These studies represented 3202 children and contained
reports of 847 adverse events. The three most frequent ADRs were vomiting,
increased blood pressure and behavioural changes. The incidence rates of these
three ADRs were 6.3%, 8.5% and 4.8%, of patients respectively. The risk of
vomiting was greater with oral prednisolone than oral dexamethasone with a
relative risk of 3.62 (95% CI 1.89, 6.95; P=0.0001, I2=30%). Prednisolone
sodium phosphate was reported to cause vomiting less frequently than other
prednisolone dosage forms (P=0.047). HPA axis suppression was detected in 43
of 53 patients who were tested. The relative risk of oral prednisolone to
cause HPA axis suppression compared with inhaled steroids was 9.95 (95% CI
1.73, 53.03; P=0.010, I2=54%). Increased susceptibility to infection was one
of the most serious ADRs, one child died after contracting a varicella zoster
infection.
Conclusions: Vomiting, increased blood
pressure and behavioural changes were the most frequent ADRs seen when
short-course oral corticosteroids were given to children. In addition,
increased susceptibility to infection was the most serious ADR. The majority
of children who received short course oral corticosteroids will experience
HPA axis suppression.
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المؤتمر (2):
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عنوان المؤتمر:
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The 15th European Society For Developmental
Perinatal And Paediatric Congress
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تاريخ الإنعقاد:
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23-26 June 2015
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مكان
الإنعقاد:
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Belgrade, Serbia
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طبيعة المشاركة:
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Oral presentation
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عنوان المشاركة:
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Short-Course Oral Corticosteroid
Toxicity In Children
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ملخص المشاركة:
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Background: Multiple studies have evaluated
and reported adverse drug reactions (ADRs) of corticosteroids. Short course
oral corticosteroids are commonly used in children in the management of
conditions such as asthma exacerbations. This systematic review aimed to
identify the most common and serious ADRs associated with short courses of
oral corticosteroids and to determine their relative risk levels in children.
Methods: A literature search of the
databases: Embase, Medline, International Pharmaceutical Abstracts, CINAHL,
the Cochrane Library and PubMed was performed to identify all studies where
corticosteroids had been administered to paediatric patients ranging from 28
days to 18 years of age for up to and including 14 days of treatment. Each
database was searched from their earliest dates to December 2013. All types
of studies that provided clear information on adverse events were included
with no language restrictions. Quality assessments were performed on all
studies by two independent reviewers.
Results: Thirty eight studies met the
inclusion criteria. These studies represented 3202 children and contained
reports of 847 adverse events. The three most frequent ADRs were vomiting,
increased blood pressure and behavioural changes. The incidence rates of
these three
ADRs were 6.3%, 8.5% and 4.8% of patients
respectively. The risk of vomiting was greater with oral prednisolone than
oral dexamethasone with a relative risk of 3.62 (95% CI 1.89, 6.95;
P=0.0001). Prednisolone sodium phosphate was reported to cause vomiting less
frequently than other prednisolone dosage forms (P=0.047). HPA axis
suppression was detected in 43 of 53 patients who were tested. The relative
risk of oral prednisolone to cause HPA axis suppression compared with inhaled
steroids was 9.95 (95% CI 1.73, 53.03; P=0.010). Infection
was one of
the most serious
ADRs, one child died after contracting a
varicella zoster infection.
Conclusions: Vomiting, increased blood
pressure and behavioral changes were the most frequent ADRs seen when
short-course oral corticosteroids were given to children. In addition,
infection was the most serious ADR. The majority of children who receive
short course oral corticosteroids will experience HPA axis suppression.
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المؤتمر (3):
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عنوان المؤتمر:
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The Neonatal And Paediatric
Pharmacists Group (NPPG) 21st Annual Conference
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تاريخ الإنعقاد:
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6–8 November 2015
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مكان
الإنعقاد:
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Cheshire, UK
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طبيعة المشاركة:
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Oral presentation
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عنوان المشاركة:
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Long-Course Oral Corticosteroids
Toxicity In Children
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ملخص المشاركة:
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BACKGROUND: Long courses of oral
corticosteroids are commonly used in children in the management of conditions
such as nephrotic syndrome, leukaemia, asthma and others. Various adverse
drug reactions (ADRs) are known to occur with their use. This systematic
review aimed to identify the most common and serious ADRs and to determine
their relative risk levels.
METHODS: A literature search of several
databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL,
the Cochrane Library and PubMed was performed to identify all studies where
corticosteroids had been administered to paediatric patients ranging from 28
days to 18 years of age for at least 15 days of treatment. Each database was
searched from their earliest dates to March 2014. All types of studies that
provided clear information on ADRs were included.
RESULTS: 91 relevant studies were found
from 27 countries. These studies represented a total of 6653 children and
contained reports of 4124 ADRs, the majority in patients with leukaemia,
haemangioma and asthma. Oral prednisolone was the most commonly prescribed
corticosteroid (74% of patients). The three most frequent ADRs were weight
gain, Cushingoid features and growth retardation. The incidence rates of
patients with these three ADRs were 22.4%, 20.6% and 18.9%, respectively.
Increased susceptibility to infection was the most serious ADR. 24 children
died from infections, ten from varicella zoster and the others from different
microorganisms.
CONCLUSIONS: Weight gain, Cushingoid
features and growth retardation were the most frequent ADRs seen when
long-course oral corticosteroids were given to children. In addition,
increased susceptibility to infection was the most common cause of mortality.
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المؤتمر (4):
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عنوان المؤتمر:
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The Neonatal And Paediatric
Pharmacists Group (NPPG) 21st Annual Conference
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تاريخ الإنعقاد:
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6–8 November 2015
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مكان
الإنعقاد:
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Cheshire, UK
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طبيعة المشاركة:
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Oral presentation
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عنوان المشاركة:
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Tolerability Of Prednisolone And
Dexamethasone In Children In Saudi Arabia
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ملخص المشاركة:
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Background: Corticosteroids are used to
treat a variety of medical conditions including acute asthma and croup where
they are often given in short-courses. Epidemiological studies in Saudi
Arabia show an increasing prevalence of respiratory diseases such as asthma in
the past three decades. This study aimed to evaluate the tolerability and
palatability of oral prednisolone and dexamethasone in children in Saudi
Arabia. Both drugs are available in different formulations from different
pharmaceutical companies.
Methods: Prospective observational and
interview study. The palatability of the oral corticosteroids was evaluated
by asking children and their parent’s opinions of the taste and acceptability
of the medication soon after drug administration. Children were asked to
point at the appropriate face on a 10-cm visual analogue scale depicting five
degrees of pleasure: 1 ‘dislike very much, 2 ‘dislike a little’, 3 ‘not
sure’, 4 ‘like a little’ and 5 ‘like very much’. The tolerability of the
drugs, in particular nausea, vomiting and abdominal pain was also evaluated
by direct questioning of the parent/patients after each drug administration,
and at the end of the course. Data was collected over three months, February
to April 2015. Patients aged 2–18 years with any condition being treated with
oral prednisolone or dexamethasone in hospital were approached to
participate.
Results: 122 patients (89 with asthma and
33 with croup) age range 2–11 years (mean=4.3) were recruited. 52 patients
were given prednisolone base tablets, 37 patients were given prednisolone
sodium phosphate syrup and 33 patients dexamethasone oral solution.
The palatability score was lowest for the
prednisolone base tablet (Mean rating=1.12), (prednisolone sodium phosphate
group, Mean=1.62, 95% CI −0.75, −0.26; P=0.000001) (dexamethasone group,
Mean=1.97, 95% CI −1.11, −0.6; P=0.000001). Dexamethasone was rated the most
palatable (prednisolone sodium phosphate, 95% CI 0.08, 0.62; P=0.012). Nausea
and vomiting occurred only in patients given prednisolone base tablets (24
and five patients respectively). Both were statistically more frequent when
compared with the prednisolone sodium phosphate group (only four patients had
nausea) (95% CI 0.19, 0.52; P=0.000001 and 95% CI 0.1, 0.18; P=0.024
respectively). In the dexamethasone group only two patients had nausea.
Abdominal pain was reported in 13 patients given prednisolone sodium
phosphate syrup compared to eight patients in the prednisolone tablet group
(95% CI 0.02, 0.38; P=0.032). In the dexamethasone group eight patients had
abdominal pain.
Conclusions: Dexamethasone was the most
palatable preparation though it did cause abdominal pain in nearly one
quarter of patients. Prednisolone base tablets were rated the least palatable
preparation and were also the least well tolerated.
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المؤتمر (5):
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عنوان المؤتمر:
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The Neonatal And Paediatric Pharmacists
Group (NPPG) 22nd Annual Conference
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تاريخ الإنعقاد:
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4-6
November 2016
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مكان
الإنعقاد:
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Birmingham, UK
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طبيعة المشاركة:
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Oral presentation
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عنوان المشاركة:
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Tolerability Of Prednisolone And
Dexamethasone In Children In Saudi Arabia And The United
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ملخص المشاركة:
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Background: Corticosteroids are used to
treat conditions including acute asthma and croup where they are often given
in short-courses. This study evaluated the tolerability and palatability of
oral prednisolone and dexamethasone in children in Saudi Arabia (SA) and the
UK.
Methods: A prospective
observational/interview study was performed. Palatability was evaluated by
asking patient/parent’s opinions of the taste and acceptability of the
medication. Children pointed at the appropriate face on a scale depicting: 1
‘dislike very much’, 2 ‘dislike a little’, 3 ‘not sure’, 4 ‘like a little’
and 5 ‘like very much’1. Tolerability, in particular nausea, vomiting and
abdominal pain was evaluated by direct questioning of the patient/parents
after each administration. Data was
collected over three months in each centre. Patients aged 2–18 years treated
with oral prednisolone or dexamethasone in hospital were approached to
participate.
Results: In SA, 122 patients (89 asthma, 33
croup), aged 2–10 years (mean=4.3) were recruited: 52 received prednisolone
base tablets; 37 prednisolone sodium phosphate syrup; 33 dexamethasone
elixir. In the UK, of 133 patients (80 asthma, 53 croup) aged 2–16 years
(mean=4.9): 38 received prednisolone base tablets; 42 prednisolone sodium
phosphate soluble tablets; 53 dexamethasone sodium phosphate oral solution.
SA: Day 1 prednisolone base tablet
palatability scores: 1 (88.5%); 2 (11.5%).
Day 2 scores: 1 (64.4%); 2 (28.9%); 3 (6.7%). Day 1 prednisolone
sodium phosphate solution palatability scores: 1 (48.6%); 2 (40.5%); 3
(10.8%). Day 2 scores: 1 (10.8%); 2 (67.6%); 3 (21.6%). Day 1 dexamethasone
elixir palatability scores: 1 (27.3%); 2 (48.5%); 3 (24.2%).
UK: Day 1 prednisolone base tablet
palatability scores: 1 (76.3%); 2 (13.1%); 3 (5.3%); 4 (5.3%). Day 2 scores:
1 (61.3%); 2 (19.4%); 3 (16.1%); 4 (3.2%).
Day 1 prednisolone sodium phosphate soluble tablet palatability
scores: 1 (35.7%); 2 (26.2%); 3 (23.8%); 4 (11.9%) 5 (2.4%). Day 2 scores: 1
(16.7%); 2 (58.2%); 3 (16.7%); 4 (4.2%); 5 (4.2%). Day 1 dexamethasone sodium
phosphate solution palatability scores: 1 (5.7%); 2 (28.3%); 3 (37.7%); 4
(17%); 5 (11.3%).
Dexamethasone sodium phosphate solution had
the highest palatability scores (P˂0.0001). The score was lowest for
prednisolone base tablets in both centres (P˂0.0001).
In SA prednisolone base tablets were
associated with more cases of nausea (24 vs 7) and vomiting (5 vs 0) than prednisolone
sodium phosphate syrup (P=0.008 and P=0.073 respectively). In the UK vomiting
occurred significantly more frequently with prednisolone base tablets (8)
than prednisolone sodium phosphate soluble tablets (2) (P=0.041). In both
centres dexamethasone was associated with less side effects but with no
significant difference between the formulations. Vomiting (1 vs 0), nausea (7
vs 3) and abdominal pain (10 vs 8) occurred more with dexamethasone sodium
phosphate solution than dexamethasone elixir (P=1, P=0.53 and P=0.55
respectively).
Conclusions: Dexamethasone sodium phosphate
solution was the most palatable preparation. Prednisolone base tablets were
rated the least palatable and were also the least well tolerated.
Palatability scores seemed to improve with second doses.
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