BACKGROUND: Since there is still no definitive conclusion regarding which 
non-steroidal anti-inflammatory drugs (NSAIDs) are most effective and safe in 
viral respiratory infections, we decided to evaluate the efficacy and safety of 
various NSAIDs in viral respiratory infections so that we can reach a conclusion 
on which NSAID is best choice for coronavirus disease 2019 (COVID-19).
METHODS: A search was performed in Medline (via PubMed), Embase and CENTRAL 
databases until 23 March 2020. Clinical trials on application of NSAIDs in viral 
respiratory infections were included.
RESULTS: Six clinical trials were included. No clinical trial has been performed 
on COVID-19, Severe Acute Respiratory Syndrome and Middle East Respiratory 
Syndrome infections. Studies show that ibuprofen and naproxen not only have 
positive effects in controlling cold symptoms, but also do not cause serious 
side effects in rhinovirus infections. In addition, it was found that 
clarithromycin, naproxen and oseltamivir combination leads to decrease in 
mortality rate and duration of hospitalisation in patients with pneumonia caused 
by influenza.
CONCLUSION: Although based on existing evidence, NSAIDs have been effective in 
treating respiratory infections caused by influenza and rhinovirus, since there 
is no clinical trial on COVID-19 and case-reports and clinical experiences are 
indicative of elongation of treatment duration and exacerbation of the clinical 
course of patients with COVID-19, it is recommended to use substitutes such as 
acetaminophen for controlling fever and inflammation and be cautious about using 
NSAIDs in management of COVID-19 patients until there are enough evidence. 
Naproxen may be a good choice for future clinical trials.