Non-Steroidal Anti-Inflammatory Drugs From an Infectious Diseases Perspective

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely prescribed with a broader indication spectrum by almost entire medical specialties due to its analgesic, antipyretic, and anti-inflammatory effects. Analgesic and antipyretic properties are the main reasons to use this group of drugs by clinicians despite the preference of Infectious Diseases experts for all three types of effects in patients with infection. However, the use of higher doses of NSAIDs for longer durations, commonly seen in the treatment of rheumatologic diseases, may lead to the deterioration in neutrophil and vascular endothelial function. These manifestations may theoretically help in developing an infection, although these effects are not prominent in therapeutic doses. Besides, it may also lead to a delay in admission and initiation of treatment as it may mask infection symptoms. Drug interactions in NSAIDs have been practically considerable and require a cautious approach, especially in interactions with antimicrobials. It is an important issue, although paid no attention generally. For example, using NSAIDs combined with quinolone antimicrobials may lead to side effects in the central nervous system like trembling, involuntary muscle contractions, anxiety, confusion, depression, hallucination or attacks. NSAIDs may have serious side effects like gastrointestinal bleedings and deterioration of renal functions. They may lead to kidney damage in different forms, hemodynamically by renal vasoconstriction, acute renal injury by acute tubular necrosis and acute interstitial nephritis, fluid and electrolytes imbalance by inhibition of prostaglandins, acid-base imbalance, and nephrotic syndrome. Due to aggravating effects on renal function, these drugs should be used cautiously or avoided in patients with gastroenteritis in terms of fluid and electrolytes imbalance or in patients with upper urinary tract infections that may cause renal injury. Combined use with antimicrobials that may alter kidney functions mainly with aminoglycosides should be approached cautiously, and kidney functions should be monitored closely during the treatment. In this chapter, the role of NSAIDs in the practice of Infectious Diseases is discussed in light of current information. © 2021 by Nova Science Publishers, Inc. All rights reserved.