Voiriot G, Chalumeau M, Messika J, Basille D, Philippe B, Ricard J-D, Andrejak C, Jounieaux V, Sanchez O, Fartoukh M
Service de réanimation médico-chirurgicale, hôpital Tenon, hôpitaux universitaires de l'Est-Parisien, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
Service de pédiatrie générale et maladies infectieuses, hôpital universitaire Necker-Enfants-Malades, Assistance publique-hôpitaux de Paris, 75015 Paris, France; Faculté de médecine, université Paris-Descartes-Paris-V, 75006 Paris, France.
Rev Mal Respir. 2018 Apr;35(4):430-440. doi: 10.1016/j.rmr.2017.12.003. Epub 2018 May 10.
Outpatient treatment of community-acquired pneumonia (CAP) patients with non-steroidal anti-inflammatory drugs (NSAIDs) is frequent, although this is not based on clinical recommendations and there is no scientific evidence supporting better symptom relief in comparison to acetaminophen.
Experimental data suggest that NSAIDs alter the intrinsic functions of neutrophils, limit their locoregional recruitment, alter bacterial clearance and delay the resolution of inflammatory processes during acute bacterial pulmonary challenge. In hospitalized children and adults with CAP, observational data suggest a strong and independent association between the outpatient exposure to NSAIDs and the occurrence of pleuropulmonary complications (pleural empyema, excavation, and abscess). In the only study taking into account possible protopathic bias, the association still persists. Other markers of morbidity have been described, including delay in hospital management, prolonged antibiotic therapy, and higher transfer rate to an intensive care unit.
Data describing the role of self-medication and the biological mechanisms involved are needed.
Intake of NSAIDs during outpatient treatment of CAP is probably the second modifiable factor of morbidity after inadequate antibiotic therapy. In light of existing data in children and adults, health authorities should urgently reassess the risk-benefit ratio of NSAIDS in CAP.
社区获得性肺炎（CAP）患者门诊使用非甾体类抗炎药（NSAIDs）的情况很常见，尽管这并非基于临床建议，且没有科学证据表明与对乙酰氨基酚相比，NSAIDs能更好地缓解症状。
实验数据表明，NSAIDs会改变中性粒细胞的固有功能，限制其局部募集，改变细菌清除，并在急性细菌性肺部感染时延迟炎症过程的消退。在住院的CAP儿童和成人中，观察数据表明门诊使用NSAIDs与胸膜肺部并发症（胸膜脓胸、空洞形成和脓肿）的发生之间存在强烈且独立的关联。在唯一一项考虑了可能的原发病偏倚的研究中，这种关联仍然存在。还描述了其他发病指标，包括住院治疗延迟、抗生素治疗时间延长以及转入重症监护病房的比例更高。
需要有关自我用药作用及相关生物学机制的数据。
CAP门诊治疗期间使用NSAIDs可能是继抗生素治疗不足之后第二个可改变的发病因素。鉴于儿童和成人的现有数据，卫生当局应紧急重新评估NSAIDs在CAP中的风险效益比。
