Treatment Cold and Flu

This section is about what over the counter treatments are available (not all treatments may be available in that country) and how they help.

Cough and cold medicines offer only temporary relief of common symptoms, such as runny nose, cough, nasal congestion, fever and aches.
They do not affect the severity of the viral infection or shorten the time the infection lasts.

Get better without antibiotics

Get better without using antibiotics

Get the right treatment for common illnesses such as colds and coughs without encouraging antibiotic resistance.

How should I treat my cold?
The best way to treat most colds, coughs or sore throats is to drink plenty of fluids and to rest. Colds can last about two weeks and may end with a cough and bringing up phlegm. There are many over the counter remedies to ease the symptoms – paracetamol, for example. Ask your pharmacist for advice. If the cold lasts more than three weeks, or you become breathless or have chest pains, or already have a chest complaint, see your doctor.

What about my children, they’re always getting coughs and colds?
It’s very common for children to get coughs and colds, especially when they go to school and mix with other children. Ask your pharmacist for advice. If the symptoms persist and you are concerned, see your doctor but you shouldn’t expect to be prescribed antibiotics.

Why should antibiotics not be used to treat coughs and colds?
All colds and most coughs and sore throats are caused by viruses. Antibiotics do not work against infections, such as colds, caused by viruses. Viral infections are much more common than bacterial infections.

What are antibiotics?
Antibiotics are important medicines used to treat infections caused by bacteria. Bacteria can adapt and find ways to survive the effects of an antibiotic. They become ‘antibiotic resistant’ so that the antibiotic no longer works. The more often we use an antibiotic, the more likely it is that bacteria will become resistant to it. Some bacteria that cause infections in hospitals, such as MRSA, are resistant to several antibiotics.

Why can’t different antibiotics be used instead?
They can, but they may not be as effective, and they may have more side-effects. And eventually the bacteria will become resistant to them too. We cannot be sure we will always be able to find new antibiotics to replace the old ones. In recent years fewer new antibiotics have been discovered.

How can antibiotic resistance be avoided?
By using antibiotics less often we can slow down the development of resistance. It’s not possible to stop it completely, but slowing it down stops resistance spreading and buys some time to develop new types of antibiotics.

What can I do about antibiotic resistance?
By only using antibiotics when it’s appropriate to do so. We now know that most coughs and colds get better just as quickly without antibiotics. When they are prescribed, the complete course should be taken in order to get rid of the bacteria completely. If the course isn’t completed, some bacteria may be left to develop resistance.

So when will I be prescribed antibiotics?
Your doctor will only prescribe antibiotics when you need them, for example for a kidney infection or pneumonia. Antibiotics may be life-saving for infections such as meningitis. By not using them unnecessarily, they are more likely to work when we need them.

Please make sure if selecting a combination product with a cough ingredient to specifically state if you have a dry or chesty cough. Just because one has used a product before does not always mean it’s the best product this time as cold and flu symptoms can vary.

Information for children under the age of 6 years
- Cough and cold remedies containing the below ingredients should no longer be used in children under 6 years as the balance of benefits and risk has not been shown to be favourable.
- OTC cough and cold medicines containing the following active ingredients are affected by the advice: antitussives (dextromethorphan and pholcodine); expectorants (guaifenesin and ipecacuanha); nasal decongestants (ephedrine, oxymetazoline, phenylephrine, pseudoephedrine, and xylometazoline); and antihistamines (brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine, and triprolidine).
- A child under 6 years of age may appear to have a cold but actually be suffering from a more serious illness (for example: influenza, asthma, bronchitis or allergic rhinitis), which may require medical attention and treatment.
- Overdose of these medicines can lead to serious harm.
- Possible side effect include:
  - allergic reactions
  - increased or uneven heart rate
  - slow and shallow breathing
  - drowsiness or sleeplessness
  - confusion or hallucinations
  - convulsions
  - nausea
  - constipation.

Please check all ingredients and check one is not allergic or sensitive to them.

Fever

Provide fever relief and continue your daily routine.
Fever reducing medication will make one sweat that’s how they cool one down.
Fever reducing medication should only be considered in children who have fever with distress, it should not be used just to reduce fever. Treatment should only continue if the child appears to be distressed.
Paracetamol and ibuprofen can be used alternately but not at the same time. Alternating is only considered if the child is distressed or reoccurs at the next dose.

There are a wide range of painkillers and anti-inflammatory painkillers available and are available in a variety of forms from sachets, liquids, lozenges, tablets and soluble tablets.

Paracetamol

Paracetamol has no anti-inflammatory action. It does help to reduce temperature and pain by blocking signals to the brain and is gentle on the stomach.
Paracetamol must be taken to the manufacturer’s direction.
Do not exceed dose as it can be dangerous.
Please be aware Paracetamol can be found in many cold and flu products so don’t take them together or talk to your pharmacist if one is not sure.
Do not store in the fridge.

Ibuprofen, aspirin

These are known as NSAID – Non-Steroid Anti-Inflammatory Drugs.
They have painkilling, anti-inflammatory and lowering fever properties by helping to blocking prostaglandins.
They can cause stomach upset (extra caution must be taken with those who have a stomach ulcer) so it is important to have it with or after food.
It can also raise one’s blood pressure (extra caution on those with heart problems).
Do not take during chickenpox as it can to an increase chance of pneumonia and Necrotising Fasciitis
They must be taken according to manufacturer’s directions as exceeding the does can be dangerous.
Please be aware that cold and flu products have NSAIDS. Do not take at same time or talk to your pharmacist if one is not sure.

Sinus (congested, blocked or runny nose)

The aim is to clear the congestion / runny nose and many products are available.

Decongestants

Decongestants work by narrowing the blood vessels in the nose.
This then reduces tissue swelling and mucus product helping with congestion, allowing one to breathe more easily.
They can cause light headedness and should not be taken by anyone with a heart condition and/or if immunocompromised without seeing your medical doctor first.Please note pharmacy can only sell a limited amount of Pseudoephedrine/Ephedrine decongestant tablets per sale, see your pharmacist if not sure.
They can be found in combination with cold and flu remedies and cough remedies, so please be aware not to overdose and don’t take at the same time. If one is unsure talk to your pharmacist.
Nasal sprays should only be used no longer than seven days to avoid a rebound effect. They can cause local irritation and dryness of nasal passages.

Vapour Rubs

These act locally by opening the blood vessels and produce more mucus till it starts running and so it cleans out one’s nose and remove allergens/irritants.
They also are quite strong flavoured products and are believed to act on parts of the body causing sensations and help to relive your symptoms via a local anaesthetic or numbing action.
Some vapours can be added to hot water and the vapour creates a moist environment around your nose making the mucus runnier and removing allergen/irritant.
They are ideal if decongestants are not suitable and can be used same time as decongestant/antihistamines products if needed.

Saline Sprays/Drops

There are salt water products and have antiseptic properties.
They are used when decongestants are not suitable and wash out the nose from irritants/allergens.
They help particularly if one has mucus coming from the nose and down the back of the throat and causing a cough.
They can be used at the same time as decongestant/vapour rubs/if needed.

Nasal Spray (cold and flu prevention)

This product provides a coating around the allergens/irritant and trapping it,therefore not producing a brain response of congestion.
It cannot be used during flu.

Anti-histamines

These are said to help to reduce a runny nose, however it may make one drowsy. Please note that many cold and flu and cough remedies have this ingredient as well as being used for hay fever, allergies and bites.
Please don’t take at the same time. If unsure ask your pharmacist.

Cough

Aim is to cough up all the phlegm out of the chest; hopefully before it become infected otherwise antibiotics maybe required.

Chesty Cough

(Guaifenesin)

These help one to cough up phlegm stuck in their chest.
One will find that they will cough more.
The idea to get the phlegm out before bacteria starts multiplying and become a chest infection.

Other chesty cough mixtures

(squill, ipechuana, ammonium chloride)

These are thought to help one to cough up phlegm stuck in their chest.
One will find that they will cough more.
The idea to get the phlegm out before bacteria starts multiplying and become a chest infection.
They contain other agents which sooth the cough.
They also are quite strong flavoured products and are believed to act on parts of the body causing sensations and help to relive your symptoms by triggering salivation (make your mouth water and produce more mucus as well have a lubrication (coating effect) to sooth your throat and chest.

Dry Cough products

The aim is to stop by blocking the signals to the brain that causes the cough.
The side effects of such products can be drowsiness and constipation (with Dextromethorphan it is quite rare however it is not as potent as Codeine or Pholcodine).
Please be aware painkillers have Codeine and dihydrocodeine so don’t take at same time.
If unsure ask the pharmacist.
Codeine can affects ones breathing especially after surgery of the removal of tonsils in children and caution in adults.
It should only be given to adults if suitable.
Pholcodine can also cause a severe anaphylaxis reaction if used with neuromuscular blocking agents (NMBAs) used in general anaesthesia. Patients need to be aware of this if had surgery in the last 12 months and have used pholcodine.
Please note simple linctus containing products can interact with warfarin.

Tickly Cough products

(Glycerine, Honey, Lemon, Liquorice)

These have more soothing agents which act directly at the throat.
They help by protecting the throat from irritants in the throat.
They also are quite strong flavoured products and are believed to act on parts of the body causing sensations and help by relieving your symptoms via lubrication (coating effect) to help to sooth your throat and chest.
Please note simple linctus containing products can interact with warfarin.

Vapour Rubs

These act locally by opening the blood vessels and produce more mucus till it starts running and so it cleans out one’s nose and remove allergens/irritants.
They also are quite strong flavoured products and are believed to act on parts of the body causing sensations and help to relive your symptoms via a local anaesthetic or numbing action.
Some vapours can be added to hot water and the vapour creates a moist environment around your chest making the mucus runnier and removing allergen/irritant.
They can be used with chesty cough mixtures or if a chesty cough mixture is not suitable.

Sore throat

The main aim is to soothe the sore throat and bring down any inflammation (hot, red and swelling) of the throat to and provide more comfort.
Products are available in mouthwashes, sprays, soluble tablets and lozenges
Check all ingredients to make sure one is not allergic or sensitive to any ingredients or any intolerance to any ingredients.
lozenges are not suitable for very young children in case they choke

Products ranges include:

Demulcents

These products help to soothe the cough and are very sweet tasting.

Antiseptics

These products help to keep bacteria away and thus help to soothe the throat.

Anaesthetics

These products help to numb the throat and are particularly useful in a painful sort throat.
They are not suitable for young children, during pregnancy and the elderly or have sensitivity to anaesthetic agents and should not be used longer than 5 days

Mild Antibiotics

These products contain a mild antibiotic to help with a throat infection.
Please note simple linctus containing products can interact with warfarin.

Diarrhoea

Aim is to restore normal bowel motion.

Treatment includes a variety of products:

Rehydration salts (Electrolytes)

This helps to replace the fluid and salts electrolytes excreted in your diarrhoea and helps to rehydrate yourself and reducing your symptoms if tiredness, headaches and body temperature.
It needs to be made up with boiled and cooled water, it should be drunk within the hour however can be stored in the fridge up to 24 hours.

Anti-diarrhoeal

This slows your intestinal muscles down so water can be absorbed in stools.
This is used as a temporary measure to stop diarrhoea (ideally should be use after 24 hours having diarrhoea) and should not be used if one has a bacterial or parasite infection as the infection will be in the body for longer.
Please check with you pharmacist before using antidiarrheal preparations particularly dry cough mixtures that contain dextromethorphan,codeine and pholcodine.

Adsorbents

This helps to trap any foreign particles/toxins and restore your bowel activity back to normal and should be taken at least two hours apart from other medications as they can affect their absorption.
This should not be used if one is dehydrated.

Bismuth salicylate

These products help to coat the stomach lining and provide a coating in your stomach lining hence bring your guts back to normal protecting from any toxins/irritants (bacteria) and is ideal for those who have nausea with their diarrhoea.
It cannot be used by anyone who is sensitive to salicylates and aspirin.
It can constipation.

Bulk laxatives

These products retain more water and make the faeces more bulky, this then stimulates the bowels and are ideal if one also has constipation.
Do not take if one has difficulty in swallowing and one must drink plenty of water and sit or stand upright for at least an hour.
It can take several days to work and side effects include abdominal cramp and flatulence.

Vitamins

Multivitamins are not intended to prevent long term conditions, reduce infection and is not proven (or data is weak) to help with cancer.

These are essential nutrients that the body requires in small amounts to function properly.