Of 79,985 patients, 73,765 (92%) were initially treated with intravenous steroids, whereas 6220 (8%) received oral treatment. We found that % (95% confidence interval [CI], %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients died during hospitalization, whereas % (95% CI, %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients experienced the composite outcome. After multivariable adjustment, including the propensity for oral treatment, the risk of treatment failure among patients treated orally was not worse than for those treated intravenously (odds ratio [OR], ; 95% CI, -). In a propensity-matched analysis, the risk of treatment failure was significantly lower among orally treated patients (OR, ; 95% CI, -), as was length of stay and cost. Using an adaptation of the instrumental variable approach, increased rate of treatment with oral steroids was not associated with a change in the risk of treatment failure (OR for each 10% increase in hospital use of oral steroids, ; 95% CI, -). A total of 1356 (22%) patients initially treated with oral steroids were switched to intravenous therapy later in the hospitalization.
Just as taking prednisone can cause side effects, reducing the dose may cause problems as well. Prednisone is not addicting like a narcotic, but many patients experience withdrawal symptoms as the dose is reduced. These often include muscle soreness, joint pain, fatigue, and depression. Know that these effects are also temporary and worth bearing to allow a cutback in your dose. If you experience any unusual symptoms as your prednisone dose is reduced, contact your doctor. It may be necessary to temporarily increase your steroid dose until you are feeling better and then taper the dose more slowly.
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