Children under 15 account for 37.8% (20,510 of 54,300) of annual hospital admissions for acute asthma. A minimum course of 3 days’ oral steroids are recommended in the BTS/SIGN 2014 guideline on the management of asthma. Our hospital covers a population of 300,000 and dispenses the equivalent of 2,400 courses of oral steroids a year for the treatment of acute asthma and viral induced wheeze in children. A typical three-day course of soluble prednisolone (at 2mg/kg as per guidance, or approximately 20mg) costs £20.88, compared to £2.48 for the equivalent dose of non-soluble prednisolone dispensed with a tablet crusher (Table 1). Several hospital trusts have switched to using non-soluble prednisolone in order to achieve cost savings, but there have been anecdotal reports of poor palatability, raising concerns about compliance with taking medication once discharged. There is no previously published literature comparing the acceptance of non-soluble versus soluble prednisolone in children.
As part of ongoing quality improvement initiatives, the Paediatric and Pharmacy department compared tolerability of soluble versus non-soluble prednisolone in a group of 27 patients. Using a modified 5 point hedonic scale with ‘smiley’ faces we measured palatability and tolerance (swallowed versus refusal or vomiting) over two three week periods. We found acceptance of prednisolone to be similar before and after formulations were switched: 2 non-tolerated doses before (n = 17) versus 3 non-tolerated doses after the switch (n = 10). We found that ‘disguising’ the taste of the non-soluble prednisolone within a portion of sugar free jam, or mixed with 5ml of sugar-free blackcurrant cordial, helped with acceptance. The trust has since made the switch to non-soluble prednisolone for all paediatric inpatients and for take home medications. An information leaflet has been developed for parents or carers to understand how to crush the prednisolone tablets. We have not had any parent or carer reported difficulty in preparing or administering the medication. The switch from a soluble to a non-soluble formulation of prednisolone represents an annual saving of at least £44,100 for this hospital alone and, at scale, could realise huge potential savings to the NHS, without compromising patients' clinical care.
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