Hospitalization for severe bacterial infections in children after exposure to NSAIDs: a prospective adverse drug reaction reporting study.
BACKGROUND
NSAIDs are widely used to treat fever and pain in children, but their possible role in the progression of some bacterial infections is controversial.


OBJECTIVE
This study was performed to analyse reported cases of severe bacterial infection associated with NSAID exposure in children admitted for this reason to a general paediatric department.


METHODS
This study was based on the reporting system of hospital admissions for severe bacterial infections in children after NSAID exposure, and followed the recommendations of the European Guidelines of Pharmacovigilance for medicines used in a paediatric population. Data were prospectively collected and reported by active daily surveillance in the department from November 2002 to November 2005.


RESULTS
Thirty-two cases of severe bacterial infections (cellulitis, soft tissue abscesses, parapneumonic empyema, necrotizing pneumonia, adenophlegmon [fever and a tender, warm and easily compressible neck mass] and lateral or retropharyngeal abscesses) were identified in children who had received NSAIDs, principally ibuprofen, in an exposure window of 15 days before the beginning of the signs of infection. Staphylococcus aureus, group A streptococci and Streptococcus pneumoniae were identified. Seven (22%) children required surgical treatment, and four (13%) were hospitalized in an intensive care unit.


CONCLUSIONS
The frequency of hospitalization for severe bacterial infection as a possible adverse effect of NSAID use was 0.6% (95% CI 0.4, 0.9) of all admissions during the study period. The frequency of severe bacterial infections after exposure to NSAIDs was elevated (one case per month) in the department studied. Further work is necessary to confirm these findings, given the potential for recruitment and protopathic biases in our study.
Pediatric Emergency Medicine Unit - Department of Pediatrics, Cochin-Saint-Vincent-de-Paul Hospital, AP-HP, Paris-Descartes University, Paris, France.
Sandrine
S
Leroy
Elisabeth
E
Marc
Françoise
F
Bavoux
Jean-Marc
JM
Tréluyer
Dominique
D
Gendrel
Gérard
G
Bréart
Gérard
G
Pons
Martin
M
Chalumeau
D016907:Adverse Drug Reaction Reporting Systems; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000209:etiology; D013290:Streptococcal Infections / Q000139:chemically induced / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal