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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Death/hospitalization -219% Improvement Relative Risk NSAIDs for RTI  Stuart et al.  EARLY TREATMENT Is early treatment with NSAIDs beneficial for RTI? Retrospective study in the United Kingdom Higher death/hosp. with NSAIDs (p<0.000001) Stuart et al., BMJ Open, January 2024 Favors NSAIDs Favors control

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

Stuart et al., BMJ Open, doi:10.1136/bmjopen-2023-077365
Jan 2024  
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Retrospective 142,925 outpatients in the UK showing significantly higher risk of hospitalization or death with prescription of NSAIDs for respiratory tract infections (RTI) or urinary tract infections (UTI).
Practice-level analysis also found a 0.32 percentage point increase in hospitalizations/deaths for every 1 percentage point increase in NSAID prescribing.
NSAIDs may be harmful due to suppression of inflammatory and immune responses needed to clear infections. They inhibit cyclooxygenase enzymes and production of prostaglandins involved in inflammation. This anti-inflammatory effect could hamper the body's ability to fight the infection. NSAIDs may mask symptoms of worsening infection. By reducing pain, fever, and inflammation, they could provide symptomatic relief while the infection progresses unchecked, delaying further medical care. NSAIDs may increase risks of certain complications. There is some evidence linking NSAIDs to higher risk of cardiovascular events. The increased risk could also be partly explained by confounding factors not fully accounted for in the analyses, although practive-level analysis points to an association rather than confounding by indication.
Study covers ibuprofen and indomethacin.
risk of death/hospitalization, 219.0% higher, OR 3.19, p < 0.001, adjusted per study, NSAID only vs. no prescription, multivariable, day 30, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Stuart et al., 3 Jan 2024, retrospective, United Kingdom, peer-reviewed, 7 authors.
This PaperIndomethacinAll
NSAID prescribing and adverse outcomes in common infections: a population-based cohort study
Professor Beth Stuart, Roderick Venekamp, Hilda Hounkpatin, Sam Wilding, Michael Moore, Paul Little, Martin C Gulliford
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..
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