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You are the paediatric registrar on night shift in a busy district general hospital. Earlier in the day, a 2-year-old boy with symptoms and signs of lower respiratory tract infection (LRTI) was admitted to the ward. He is now febrile, and the nurse in charge contacts you to ask if she can give him a dose of ibuprofen to control his temperature. You recall a teaching session in the hospital about the association between non-steroidal anti-inflammatory drug (NSAID) use and invasive bacterial infection. You wonder if giving ibuprofen in the context of LRTI is not without risk.
Structured clinical question
In children with symptoms and signs of LRTI (population), does exposure to ibuprofen (intervention) compared with no exposure to ibuprofen (control) have any association with complicated respiratory disease (outcome)?
We searched PubMed in May 2019 using the terms (Children OR Paediatrics) AND
(Ibuprofen OR NSAID OR Non-steroidal anti-inflammatory drugs OR Anti-inflammatory)
AND (Pneumonia OR Community acquired pneumonia OR Lower respiratory tract infection
OR LRTI OR Upper respiratory tract infection OR URTI) AND (Empyema OR Pleural effusion OR Pleural empyema OR Parapneumonic effusion). We identified 54 studies. Paper titles were scrutinised, and 10 papers were selected for abstract review. Non-paediatric studies, a case report and an article only available in French were discounted leaving six papers for full-text review. A seventh relevant paper was discovered on searching the references of included studies. Table 1 summarises the articles included in our literature review. The level of evidence was graded according to the Oxford levels of evidence.1
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