Non-steroidal anti-inflammatory drugs may worsen the course of community-acquired pneumonia : A cohort study

Basille, Damien; Trouve, Charlotte; Plouvier, Nathalie; Andréjak, Claire; Jounieaux, V.

doi:10.1183/13993003.congress-2016.oa3330

Cited by 7 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is important to note that the study investigated the effects of both clarithromycin and naproxen in combination with oseltamivir and therefore any benefits seen may be due to the use of concomitant antibiotics and not NSAID use. Basille et al 26 and Voiriot et al 28 reported an uncertain effect on 30 day mortality, Messika et al 22 reported an uncertain effect on in‐hospital mortality, and Epperly et al 24 reported an uncertain effect on 90 day mortality. Although the mortality data could not be pooled due to heterogeneity, the overall direction of effect suggests there may be a trend towards a reduction in mortality.…”

Section: Resultsmentioning

confidence: 99%

The COVID‐19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections

Vaja

Chan

Ferreira

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections. Methods: We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications. Results: In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies. Conclusion: In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.

show abstract

Section: Resultsmentioning

confidence: 99%

The COVID‐19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections

Vaja

Chan

Ferreira

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…that NSAIDs were used to treat the earliest manifestations of a yet undiagnosed pneumonia) or detection bias suggested in previous studies. 10,11 In both analyses, follow-up continued until the earliest of outcome occurrence, end of study period (Sept 30 2015), crossover of exposure group or addition of comparator drug, medical or pharmacy disenrollment, death or 365 days post index date.…”

Section: Discussionmentioning

confidence: 99%

“…In the days following NSAID exposure, and after respiratory symptoms worsen, the patient is correctly diagnosed as having pneumonia. [10][11][12] In a second subgroup analysis we excluded patients with a history of cancer, cirrhosis, COPD, cystic fibrosis, HIV positive status or tracheostomy in the year prior to cohort entry given their increased risk of pneumonia and to help mimic cohorts in prior studies. 10,11…”

Section: Nsaids and Pneumonia Substudymentioning

confidence: 99%

“…In contrast, prior literature examining the relationship between NSAIDs and pulmonary complications in pneumonia has suggested protopathic bias as a possible explanation for the association. [10][11][12] Further impetus for focusing on these signals stemmed from macrolide antibiotics and NSAIDs being frequently used drugs across the entire population, thus even a small increase in the risk of heart failure or pneumonia could pose an important public health burden.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating signals generated in a large-scale sequence symmetry analyses: macrolides and heart failure; and NSAIDs and pneumonia

Sinnott

Lin

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective Using US claims data and the most up-to-date pharmacoepidemiological study design tools we aimed to investigate two safety signals for (1) macrolides and heart failure; and (2) non-steroidal anti-inflammatory drugs (NSAIDs) and pneumonia generated from a large-scale screening analysis using a self-controlled sequence symmetry design in Danish data. Methods We used IBM Marketscan data to conduct two new-user, active-comparator cohort studies. In the macrolides example, the exposure was clarithromycin or azithromycin and the comparator was amoxicillin/clavulanate, in patients with sinusitis. In the NSAIDs example, the exposure was oral NSAIDs and the comparator was topical diclofenac, in patients with osteoarthritis. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) to adjust for approximately 50 investigator-specified confounders in a propensity score (PS) matched analysis. In a secondary analysis, we used high-dimensional PS (hd-PS) to adjust for 200 additional proxy confounders. Results We had 1,012,364 propensity score matched patients exposed to clarithromycin or azithromycin versus amoxicillin/clavulanate. With 162 outcomes among clarithromycin or azithromycin exposed patients and 134 among amoxicillin/clavulanate, the HR for overall heart failure was 1.14 (95% CI 0.90-1.43). In the NSAIDs example, we included 94,490 patients after propensity score matching. With 794 pneumonia outcomes among oral NSAID patients and 700 among topical diclofenac, we found HR 0.98 (95% CI 0.89-1.09). Some upward bias was suspected as larger HRs were observed in the days immediately following exposure for both the macrolides and NSAIDs examples. We found similar results in the hd-PS matched analyses for both examples. Conclusion Our findings for NSAIDs and pneumonia suggest the original signal may have been due to protopathic or detection bias. Our analyses for macrolides and heart failure with short-term follow-up also suggest bias, although we encourage further research.

show abstract

“…For fever control and cough suppression, paracetamol and codeine are widely available and cheap, and their use is without additional risk for patients. Nonsteroidal antiinflammatory drugs are suggested to be harmful, [28][29][30] which could outweigh a potential benefit on symptom control for respiratory tract infection. 31 For light sedation, benzodiazepines and morphine are widely available and cheap.…”

Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for the Management of Acute Respiratory Failure and Mechanical Ventilation in Patients with COVID-19 in Low- and Middle-Income Countries

Neto

Checkley

Sivakorn

et al. 2021

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Management of patients with severe or critical COVID-19 is mainly modeled after care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, and these recommendations are based on evidence that often originates from investigations in resource-rich intensive care units located in high-income countries. Often, it is impractical to apply these recommendations to resource-restricted settings, particularly in low-and middle-income countries (LMICs). We report on a set of pragmatic recommendations for acute respiratory failure and mechanical ventilation management in patients with severe/critical COVID-19 in LMICs. We suggest starting supplementary oxygen when SpO 2 is persistently lower than 94%. We recommend supplemental oxygen to keep SpO 2 at 88-95% and suggest higher targets in settings where continuous pulse oximetry is not available but intermittent pulse oximetry is. We suggest a trial of awake prone positioning in patients who remain hypoxemic; however, this requires close monitoring, and clear failure and escalation criteria. In places with an adequate number and trained staff, the strategy seems safe. We recommend to intubate based on signs of respiratory distress more than on refractory hypoxemia alone, and we recommend close monitoring for respiratory worsening and early intubation if worsening occurs. We recommend low-tidal volume ventilation combined with FiO 2 and positive end-expiratory pressure (PEEP) management based on a high FiO 2 /low PEEP table. We recommend against using routine recruitment maneuvers, unless as a rescue therapy in refractory hypoxemia, and we recommend using prone positioning for 12-16 hours in case of refractory hypoxemia (PaO 2 / FiO 2 < 150 mmHg, FiO 2 ³ 0.6 and PEEP ³ 10 cmH 2 O) in intubated patients as standard in ARDS patients. We also recommend against sharing one ventilator for multiple patients. We recommend daily assessments for readiness for weaning by a low-level pressure support and recommend against using a T-piece trial because of aerosolization risk.

show abstract

Non-steroidal anti-inflammatory drugs may worsen the course of community-acquired pneumonia : A cohort study

Cited by 7 publications

References 0 publications

The COVID‐19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections

The COVID‐19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections

Evaluating signals generated in a large-scale sequence symmetry analyses: macrolides and heart failure; and NSAIDs and pneumonia

Pragmatic Recommendations for the Management of Acute Respiratory Failure and Mechanical Ventilation in Patients with COVID-19 in Low- and Middle-Income Countries

Contact Info

Product

Resources

About