Table 3 Ibuprofen exposure and pneumonia in children
1st Author, Year (Ref) | Population; Country | Study Design | Outcome | Key results | Comments |
|---|---|---|---|---|---|
Byington, 2002 [48] | 540 children with CAP; US. | Retrospective cohort study | Risk factors for development of empyema in children with CAP. | Recent ibuprofen exposure was an independent risk factor of pleural empyema [OR 4.0 (95% CI 2.5 to 6.5)] | Timing of ibuprofen use relative to empyema development could not be established. |
Leroy, 2010 [47] | 5182 children with CAP; France | Prospective, observational study | Severe bacterial infection in children who had received NSAIDs. | Frequency of hospitalization for severe bacterial infection as a possible adverse effect of NSAIDs use was 0.6% (95% CI 0.4 to 0.9). | No established causal relationship. |
François, 2010 [49] | 767 children with CAP; France | Retrospective cohort study | Factors associated with development of empyema and lung abscess among children with CAP. | Recent ibuprofen exposure was an independent risk factor of pleural empyema [OR 2.57 (95% CI 1.51 to 4.35)]. | ‘Protopathic effect’ cannot be excluded. |
Elemraid, 2015 [50] | 160 children presenting to with radiologically confirmed pneumonia; UK | Prospective, observational study | Risk factors for development of empyema requiring intervention in children with pneumonia | Children with empyema were more frequently assuming ibuprofen prior to hospital admission (82% vs 46.2%) OR 1.94 (97.5% CI 0.8 to 3.18). | Very high incidence of empyema (40/160, 25%) |
Le Bourgeois, 2016 [24] | 83 children presenting with empyema compared with 83 controls with acute viral infection; France | Prospective, case-control study | Risk of developing empyema in children assuming NSAIDs during an acute viral infection | Recent NSAID exposure was an independent risk factor of pleural empyema [OR 2.8 (1.4–5.6)] | The risk of empyema associated with NSAIDs exposure was greater for children not assuming antibiotics |
Krenke, 2018 [51] | 203 consecutive children with CAP; Poland. | Prospective, observational study | CAP risk in children assuming NSAIDs | A dose–effect relationship was found: exposure to a cumulative dose of ibuprofen higher than 78 mg/kg was significantly associated with an increased risk of pleuropulmonary complications, such as parapneumonic pleural effusion, pleural empyema, necrotizing pneumonia and pulmonary abscess [OR 2.5 (1.3–4.9)] | Higher cumulative dose of ibuprofen was associated with 2.5-fold higher OR for CAP complications. |
Meganathan, 2019 [52] | 148 children with severe CAP; India | Prospective, case-control study | Predictor of CPE/ empyema in children (2–59 months) with CAP | NSAID use: OR 4.36 (95% CI 1.86 to 10.23); p = 0.007. | Disease spectrum bias |