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An electronic search was carried out on MEDLINE, EMBASE, PsycINFO, CENTRAL and the Cochrane library to identify reports describing the immunomodulatory effects of opioid analgesics and antipyretic analgesics, and their effects in infectious diseases. In adaptive immunity, nonsteroidal anti\u2010inflammatory drugs have divergent effects: augmenting cell\u2010mediated immunity but inhibiting humoral immunity. Nonsteroidal anti\u2010inflammatory drugs have demonstrated a beneficial role in <jats:styled-content style=\"fixed-case\"><jats:italic>Mycobacterium tuberculosis<\/jats:italic><\/jats:styled-content> infection and histoplasmosis in animals, and may be plausible adjuvants to antimicrobial agents in these diseases. There is a need to evaluate these findings rigorously in human clinical trials. There is preliminary evidence demonstrating antiviral effects of indomethacin in SARS CoV\u20102 in vitro; however, uncertainty regarding its clinical benefit in humans needs to be resolved in large clinical trials. Certain opioid analgesics are associated with immunosuppressive effects, with a developing understanding that fentanyl, morphine, methadone and buprenorphine suppress innate immunity, whilst having diverse effects on adaptive immunity. Morphine suppresses key cells of the innate immunity and is associated with greater risk of infection in the postsurgical setting. Efforts are needed to achieve adequate analgesia whilst avoiding suppression of the innate immunity in the immediate postoperative period caused by certain opioids, particularly in cancer surgery.<\/jats:p>","DOI":"10.1111\/bcp.15281","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T13:29:46Z","timestamp":1646141386000},"page":"3114-3131","source":"Crossref","is-referenced-by-count":34,"title":["Immunomodulatory effects of pharmaceutical opioids and antipyretic analgesics: Mechanisms and relevance to infection"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-5125","authenticated-orcid":false,"given":"Christina","family":"Abdel Shaheed","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, Sydney School of Public Health University of Sydney  Sydney Australia"},{"name":"Institute for Musculoskeletal Health University of Sydney and Sydney Local Health District  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1978-1559","authenticated-orcid":false,"given":"Justin","family":"Beardsley","sequence":"additional","affiliation":[{"name":"Westmead Institute for Medical Research  Sydney Australia"},{"name":"Sydney Institute for Infectious Diseases University of Sydney  Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6045-6937","authenticated-orcid":false,"given":"Richard O.","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Toxicology St Vincent's Hospital  Sydney Australia"},{"name":"St Vincent's Clinical School University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4674-0242","authenticated-orcid":false,"given":"Andrew J.","family":"McLachlan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Sydney Pharmacy School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1124\/pr.112.007138"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.4.449"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02977780"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02914"},{"issue":"1","key":"e_1_2_11_6_1","first-page":"5","article-title":"Opioid System Modulates the Immune Function: A Review","volume":"1","author":"Liang X","year":"2016","journal-title":"Transl Perioper Pain Med"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/1806-9282.65.2.262"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.12968\/bjon.2019.28.10.610"},{"issue":"5","key":"e_1_2_11_9_1","first-page":"367","article-title":"Evidence on the use of paracetamol in febrile children","volume":"81","author":"Russell FM","year":"2003","journal-title":"Bull World Health Organ"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02268-16"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.12.16"},{"issue":"6","key":"e_1_2_11_12_1","first-page":"542","article-title":"Adjunctive Dexamethasone in HIV\u2010Associated Cryptococcal Meningitis. 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