NSAID prescribing and adverse outcomes in common infections: a population-based cohort study

Objectives Infections in primary care are often treated with non-steroidal anti-inflammatory drugs (NSAIDs). This study evaluates whether NSAID prescribing is associated with adverse outcomes for respiratory (RTIs) or urinary track (UTI) infections. Objectives To determine whether there is an association between NSAID prescribing and the rate of adverse outcomes for infections for individual consulting in primary care. Design Cohort study of electronic health records. Setting 87 general practices in the UK Clinical Practice Research Datalink GOLD. Participants 142 925 patients consulting with RTI or UTI. Primary and secondary outcome measures Repeat consultations, hospitalisation or death within 30 days of the initial consultation for RTI or UTI. Poisson models estimated the associations between NSAID exposure and outcome. Rate ratios were adjusted for gender, age, ethnicity, deprivation, antibiotic use, seasonal influenza vaccination status, comorbidities and general practice. Since prescribing variations by practice are not explained by case mix-hence, less impacted by confounding by indication-both individual-level and practice-level analyses are included. Results There was an increase in hospital admission/ death for acute NSAID prescriptions (RR 2.73, 95% CI 2.10 to 3.56) and repeated NSAID prescriptions (6.47, 4.46-9.39) in RTI patients, and for acute NSAID prescriptions for UTI (RR 3.03; 1.92 to 4.76). Practice-level analysis, controlling for practice population characteristics, found that for each percentage point increase in NSAID prescription, the percentages of hospital admission/ death within 30 days increased by 0.32 percentage points (95% CI 0.16 to 0.47). Conclusions In this non-randomised study, prescription of NSAIDs at consultations for RTI or UTIs in primary care is infrequent but may be associated with increased risk of hospital admission. This supports other observational and limited trial data that NSAID prescribing might be associated with worse outcomes following acute infection and should be prescribed with caution. BACKGROUND Consultations for respiratory tract infections (RTIs) are common in primary care. A recent study using Clinical Practice Research Datalink (CPRD) practices found a consulting rate of 217 consultations per 1000 person years. 1 Urinary tract infection (UTI) are also common, with 11% of women experiencing at least one episode each year. 2 Most patients are be advised to self-manage infections at home and many use analgesics such as paracetamol and non-steroidal antiinflammatory drugs (NSAIDs) for symptom relief. 3 4 However, observational studies suggest that the use of NSAIDs during RTIs may be associated with increased risk of acute cardiovascular events, 5 and cyclooxygenase-2 inhibitors or non-selective NSAIDs may be associated with a further increase in risk. 6 7 There is also some evidence that exposure to NSAIDs during an episode of an acute infection may result in an increased risk of adverse..