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Non-steroids anti-inflammatory drugs and risk of peritonsillar abscess in pharyngitis: a French longitudinal study in primary care

Cedric Piroulas, Louise Devillers, Cecile Souty, Jonathan Sicsic, Philippe Boisnault, Mathilde François

Etude issue des données de l'Observatoire de la Médecine Générale (OMG)

Abstract

Background
The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature.

Objective
To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care.

Method
A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model.

Results
During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6–5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3–7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5–13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7).

Conclusion
Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis.

Keywords: Common illnesses, ear, nose and throat (ENT, otolaryngology), infectious diseases, pharmacology/drug reactions, primary care, upper respiratory infections/common cold/bronchitis

Topic: anti-inflammatory agents antibiotics consultation adrenal corticosteroids glucocorticoids anti-inflammatory agents, non-steroidal peritonsillar abscess pharyngitis primary health care steroids

Issue Section: Primary care epidemiology

Authors

Cedric Piroulas
Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines,
Correspondence to Cedric Piroulas, Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, 78910 Orvilliers, France, E-mail: cedric.piroulas@live.fr

Louise Devillers
Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France

Cecile Souty
Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie
et de Santé Publique (IPLESP UMR-S1136), F75012, Paris, France

Jonathan Sicsic
Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, 94807 Villejuif cedex, France

Philippe Boisnault
Société Française de Médecine Générale (SFMG), Issy les Moulineaux, France

Mathilde François
Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
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