Sunday, January 18, 2009

Some Suggestions for Selecting Liquid Corticosteroid or Antibiotic Medications Based on Taste for Parents and Physicians

I recently came across an interesting article on the taste of corticosteroid suspensions. The article by Regan and two others compared the taste of eight commonly prescribed liquid corticosteroid suspensions. The most palatable were grape-flavored suspensions (Orapred and Pediapred) over cherry-flavored suspensions. Since I almost always prescribe this formulation for children, I was happy. For those who have never tasted a corticosteroid pill, let me assure you, it is bitter and has a bad aftertaste (yuck!). It is not as bad as quinine, which one takes for malaria treatment or prevention. I took this when I visited rural China on a mission trip some years ago. (Trivia: gin and tonic water, containing quinine, was invented in India to help the British Army take the quinine. No wonder.)

Here's a slight tangent: palatability of antibiotics. In 2000, an analysis by Holas, Omnicef was found to be better tasting than amoxicillin, Augmentin, Cefzil, and Zithromax. In a 2005 Polish study by Kardas and Muras, cephalosporins > (sulpas, amoxicillin > Augmentin) > (macrolides (Biaxin, Zithromax) and clindamycin). Finally, a 2001 article by Steele found "overall taste (palatability) ranking of antibiotics, highest to lowest, was as follows: loracarbef, cefdinir (Omnicef), cefixime, azithromycin, ciprofloxacin, trimethoprim-sulfamethoxazole, clarithromycin, trimethoprim, amoxicillin/clavulanate, cefpodoxime and cefuroxime." This is in contract to Kardas' article. These are the only three articles I can find on PubMed in the past eleven years. I hope I helps. [By the way, here's my disclaimer: I don't own any stock in any drug companies.] We have to consider the real-time cost of these medications, even if generic, so my choice is partially guided by what's been used before, clinical context, and what's on their insurance's drug plan.

Any treatment plan must include the variable of compliance: meaning the patient has to take the medication as instruction completely. Otherwise the greatest medication in the world won't do any good and then there's wasted time, money, suffering, and frustration. This is certainly the case with children. I have four kids and it's been a major struggle getting (read: World War 3) each one of them to swallow their medications when they were infants. They would all spit their meds out, have a complete fit, choke, cough, gag and then vomit the meds back out, usually onto me, rather than peacefully swallow their medications. So yes, we asked to have pleasantly-flavored meds or even let them drink something sweet right afterwards.

If you have questions about the taste of medications, ask your doctor...

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