Nonsteroidal anti-inflammatory drugs (NSAIDs) given in the early stages of lower respiratory tract infection could be helping send younger adults to the intensive care unit (ICU) with serious pneumonia, say researchers from Hôpital Louis Mourier, Colombes, and Université Paris Diderot, both in France. Their concerns were triggered in part by witnessing several cases of unexpectedly severe forms of Streptococcus pneumoniae (S pneumoniae) community-acquired pneumonia (CAP) in healthy adults.
They analyzed data on 106 patients admitted with pneumococcal pneumonia or S pneumoniae and pneumonia as the discharge diagnosis. Twenty patients had received NSAIDs within 4 days prior to admission. The patients given NSAIDs were younger than those who were not prescribed NSAIDs (aged 43 years on average vs aged 62 years on average), usually working, and less likely to have comorbidities. The mean duration of NSAID treatment was 4 days. The time to the first medical consultation after pneumonia-related symptoms appeared was the same in both groups, but the patients on NSAIDs were prescribed antibiotics significantly later than those not taking NSAIDs (4.5 days vs 2 days, P = .001). They were also admitted to the ICU later.
A “noticeable and significant difference” was that more patients in the NSAID group had pleural effusion (P < .0006). New onset of pleuropulmonary complications during the ICU stay was significantly greater in the group who had received NSAIDs than in the no-NSAID group (P = .0008).
The researchers say their findings “highlight the overlooked risk of taking NSAIDs to treat physical symptoms at an early stage of CAP.” They hypothesize that patient age and comorbidity status led physicians to not diagnose CAP, and thus withhold antibiotics. NSAIDs may blunt general signs and symptoms and mask the severity of the infectious process, the researchers caution. Thus, they recommend ensuring appropriate antibiotic coverage along with NSAIDs.
In a survey of French general practitioners’ prescriptions, NSAIDs were prescribed for almost half of all patients seen for lower respiratory tract infection, “despite the fact that this prescription never appears in any national or international guideline,” the researchers say. That underscores the need to better inform general practitioners about the risks of NSAIDs, they say.
Source
Messika J, Sztrymf B, Bertrand F, et al. J Crit Care. 2014;29(5):733-738.
doi: 10.1016/j.jcrc.2014.05.021.