Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study

Muriel Le Bourgeois (1) , Agnès Ferroni (1) , Marianne Leruez-Ville (1) , Emmanuelle Varon (2, 3) , Caroline Thumerelle (4) , François Brémont (5) , Michael J Fayon (6, 7) , Christophe Delacourt (1, 8) , Caroline Ligier (9, 10) , Laurence Watier (9, 10) , Didier Guillemot (9, 10, 11)

1 Hôpital Necker - Enfants Malades [AP-HP]
2 HEGP - Hôpital Européen Georges Pompidou [APHP]
3 Centre National de Référence des Pneumocoques (CNRP)
4 Hôpital Jeanne de Flandre [Lille]
5 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
6 CHU Bordeaux
7 CIC Bordeaux
8 UPD5 Médecine - Université Paris Descartes - Faculté de Médecine
9 PhEMI - Pharmacoépidémiologie et maladies infectieuses
10 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
11 Hôpital Raymond Poincaré [AP-HP]

Objective To investigate the risk factors of empyema after acute viral infection and to clarify the hypothesized association(s) between empyema and some viruses and/or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).Study design A case-control study was conducted in 15 centers. Cases and controls were enrolled for a source population of children 3-15 years of age with acute viral infections between 2006 and 2009.Results Among 215 empyemas, 83 cases (children with empyema and acute viral infection within the 15 preceding days) were included, and 83 controls (children with acute viral infection) were matched to cases. Considering the intake of any drug within 72 hours after acute viral infection onset and at least 6 consecutive days of antibiotic use and at least 1 day of NSAIDs exposure, the multivariable analysis retained an increased risk of empyema asso-ciated with NSAIDs exposure (aOR 2.79, 95% CI 1.4-5.58, P = .004), and a decreased risk associated with antibiotic use (aOR 0.32, 95% CI 0.11-0.97, P = .04). The risk of empyema associated with NSAIDs exposure was greater for children not prescribed an antibiotic and antibiotic intake diminished that risk for children given NSAIDs.Conclusions NSAIDs use during acute viral infection is associated with an increased risk of empyema in children, and antibiotics are associated with a decreased risk. The presence of antibiotic-NSAIDs interaction with this risk is suggested. These findings suggest that NSAIDs should not be recommended as a first-line antipyretic treatment during acute viral infections in children.

Keywords: NSAIDs; children; empyema

Domains: Pulmonology and respiratory tract

Muriel Le Bourgeois, Agnès Ferroni, Marianne Leruez-Ville, Emmanuelle Varon, Caroline Thumerelle, et al.. Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study. The Journal of Pediatrics, 2016, 175, pp.47-53.e3. ⟨10.1016/j.jpeds.2016.05.025⟩. ⟨inserm-04152522⟩