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

Beth Stuart; Roderick Venekamp; Hilda Hounkpatin; Sam Wilding; Michael Moore; Paul Little; Martin C Gulliford

doi:10.1136/bmjopen-2023-077365

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

BMJ Open. 2024 Jan 3;14(1):e077365. doi: 10.1136/bmjopen-2023-077365.

Authors

Beth Stuart^{1

2}, Roderick Venekamp³, Hilda Hounkpatin², Sam Wilding⁴, Michael Moore², Paul Little², Martin C Gulliford⁵

Affiliations

¹ Wolfson Institute of Population Health, Queen Mary University of London, London, UK b.l.stuart@qmul.ac.uk.
² Primary Care Research Centre, University of Southampton Faculty of Medicine, Southampton, UK.
³ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht, Netherlands.
⁴ Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
⁵ King's College London, UK, London, UK.

Abstract

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.

Keywords: Primary Care; Respiratory infections; Urinary tract infections.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Cohort Studies
Drug Prescriptions
Female
Humans
Infections* / drug therapy
Infections* / epidemiology
Male
Practice Patterns, Physicians'
Respiratory Tract Infections* / epidemiology
Urinary Tract Infections* / chemically induced
Urinary Tract Infections* / drug therapy
Urinary Tract Infections* / epidemiology

Substances

Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal