Ibuprofen, ketoprofen: authorities warn about risks of infectious complications

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PRECAUTION – The two best-selling anti-inflammatory drugs could promote serious infectious complications, alerting the Medicines Agency that calls for "vigilance" and recalls tips for use.

The Medicines Agency (ANSM) on Thursday called for "vigilance" regarding the consumption of ibuprofen (Nurofen, Advil, Upfen, Antarene, etc.) and ketoprofen (Profenid, Toprec, Ketum), the two anti-inflammatory drugs. inflammatory drugs. Sometimes taken without precaution, they could promote serious infectious complications.

According to a drug agency survey, "in 18 years, from 2000 to 2018, 337 cases of infectious complications including 32 deaths were reported for ibuprofen and 46 cases including ten deaths with ketoprofen", explains to the AFP Dr. Philippe Vella, director of analgesic drugs at the ANSM. These two nonsteroidal anti-inflammatory drugs (NSAIDs) were already reported for serious infectious complications.

Which infections are affected?

This survey, entrusted by the ANSM to the regional pharmacovigilance centers of Tours and Marseille, has retained only the most serious cases occurring in children and adults (often young) without any particular risk factor, such as being immunocompromised. These cases are severe infections that lead to hospitalizations, sequelae and death.

These infections affect the skin and soft tissues such as "necrotizing fasciitis", an infection caused by a germ (essentially a streptococcus) nicknamed "flesh-eating" bacteria, cause of amputation and death. It can also be septicemia ("sepsis"), pneumonia complicated abscess, pleurisy, brain abscess or ENT infections reaching the chest (mediastinitis).

Infectious complications occurred while ibuprofen or ketoprofen were prescribed or taken in self-medication in fever but also in many other circumstances: benign cutaneous lesions of inflammatory appearance (local reaction, insect bite …), respiratory manifestations (cough, pulmonary infection …) or ENT (difficulty swallowing, angina, otitis …). The infections, mainly due to streptococci or pneumococci, were observed after a very short treatment period (2 to 3 days), including when combined with antibiotic therapy.

Privilege paracetamol

"The findings of this survey suggest the aggravating role of these NSAIDs in case of infection," especially those due to streptococcus, notes the ANSM, which states that the use of NSAIDs persists in case of chickenpox while they must be avoided in favor of paracetamol, otherwise there is the risk of serious cutaneous bacterial destruction.

More generally, continues the ANSM, paracetamol should be favored in case of pain and / or fever, especially during common infections (angina, nasopharyngitis, otitis, cough, pulmonary infection, skin lesions or chickenpox …), especially in self-medication. These anti-inflammatories should be used "at the lowest effective dose, for the shortest duration", ie "not more than 3 days in case of fever and 5 days in case of pain".

"If the symptoms worsen, you have to talk to your pharmacist and see your doctor," advises Dr. Vella. Another rule, do not take at the same time two drugs of this large family of NSAIDs (naproxen, diclofenac …), sold under various names.

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