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Nonsteroidal anti-inflammatory drugs in pharyngitis: risk of peritonsillar abscess

To relieve fever or sore throat, it is better not to use nonsteroidal anti-inflammatory drugs (NSAIDs), but to use paracetamol instead.

In 2017, an epidemiological study was carried out on the risks of peritonsillar abscess after pharyngitis. From the database of the Observatory of General Medicine based on input from more than 120 doctors in France, the analysis covered 105 802 pharyngitis in approximately 68 000 patients who consulted for pharyngitis between 1995 and 2010.

48 cases of peritonsillar abscess were reported in 47 patients within 15 days of a diagnosis of pharyngitis, or 1 peritonsillar abscess for 2204 pharyngitis. The risk of peritonsillar abscess was statistically significantly higher in patients who received a nonsteroidal anti-inflammatory drug (NSAID) as analgesic and also in patients prescribed a corticosteroid.

Patients who took NSAIDs had approximately twice as many peritonsillar abscesses (1 peritonsillar abscess for every 1158 pharyngitis). Patients who took a corticosteroid had 3 times more peritonsillar abscess (1 peritonsillar abscess for 824 pharyngitis). This holds true whether or not the patient had also taken an antibiotic.

NSAIDs expose patients to aggravated infections, probably by damaging the immune response.

In practice, the risk of NSAIDs and corticosteroids aggravating infections is known. To relieve fever or pain associated with an infection, non-drug measures should be considered as the first choice, and paracetamol as the drug of choice.

©Prescrire 1 January 2019

"Pharyngitis and NSAID: peritonsillar abscess" Prescrire Int 2019; 28 (200): 18. (Pdf, subscribers only).

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