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J R Soc Med. 2010 Oct;103(10):403-11. doi: 10.1258/jrsm.2010.090441.

The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis.

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  • 1Medical Research Institute of New Zealand Private Bag 7902, Wellington 6242, New Zealand.

Abstract

OBJECTIVE:

To determine whether antipyretic treatment for influenza infection influences the risk of mortality in animal models and humans.

DESIGN:

A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials was undertaken to identify randomized placebo-controlled trials of antipyretic use in influenza infection in animal models or humans that reported mortality. A quantitative meta-analysis of the risk of death using Peto's one step odds ratio with calculation of the pooled risk of death and standard evaluation of heterogeneity was undertaken.

SETTING:

Not applicable.

PARTICIPANTS:

Not applicable.

MAIN OUTCOME MEASURES:

Risk of mortality associated with antipyretic use in influenza infection.

RESULTS:

Eight studies from three publications met the inclusion criteria. No human studies were identified. The risk of mortality was increased by antipyretic use in influenza-infected animals with a fixed effects pooled odds ratio of 1.34 (95% CI 1.04-1.73). An increased risk was observed with aspirin, paracetamol and diclofenac.

CONCLUSION:

In animal models, treatment with antipyretics for influenza infection increases the risk of mortality. There are no randomized placebo-controlled trials of antipyretic use in influenza infection in humans that reported data on mortality and a paucity of clinical data by which to assess their efficacy. We suggest that randomized placebo-controlled trials of antipyretic use in human influenza infection are urgently required, and that these are sufficiently powered to investigate a potential effect on mortality.

PMID:
20929891
[PubMed - indexed for MEDLINE]
PMCID:
PMC2951171
Free PMC Article

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