NSAID prescribing and adverse outcomes in common infections: a population-based cohort study
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.
Primary Care, Respiratory infections, Urinary tract infections
e077365
Stuart, Beth
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Venekamp, Roderick
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Hounkpatin, Hilda
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Wilding, Sam
a026cae1-cc72-49b5-a52b-ec1d931d72e1
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gulliford, Martin C.
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3 January 2024
Stuart, Beth
3ca05dc5-6f43-4f47-9d12-f4ead0034716
Venekamp, Roderick
a6f843f9-c86f-41b4-913f-5247bbfe2dd3
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Wilding, Sam
a026cae1-cc72-49b5-a52b-ec1d931d72e1
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gulliford, Martin C.
f6866310-c305-464b-92e2-e69bed8d55ef
Stuart, Beth, Venekamp, Roderick, Hounkpatin, Hilda, Wilding, Sam, Moore, Michael, Little, Paul and Gulliford, Martin C.
(2024)
NSAID prescribing and adverse outcomes in common infections: a population-based cohort study.
BMJ Open, 14 (1), , [e077365].
(doi:10.1136/bmjopen-2023-077365).
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.
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More information
Accepted/In Press date: 19 November 2023
e-pub ahead of print date: 3 January 2024
Published date: 3 January 2024
Additional Information:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
Primary Care, Respiratory infections, Urinary tract infections
Identifiers
Local EPrints ID: 486040
URI: http://eprints.soton.ac.uk/id/eprint/486040
ISSN: 2044-6055
PURE UUID: b934ec17-0b72-416e-8561-9fad33863997
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Date deposited: 08 Jan 2024 17:32
Last modified: 12 Jul 2024 01:59
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Contributors
Author:
Beth Stuart
Author:
Roderick Venekamp
Author:
Martin C. Gulliford
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