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The Facts About Medications for Colds and the Flu
| By Rachael Flynn, MPH, Elizabeth
Eckel, and Diana Zuckerman, PhD |
January 2008 |
Medication doesn't cure common colds or the flu
No one wants to stay home feeling miserable with a cold or the
flu. Many adults go to the doctor in search of a cure, or at least
some medicine that will keep them, or their children, from missing
work or school. However, there is no quick fix for a cold or the
flu.
Most colds and respiratory infections are caused by viruses, as
is the flu. Unfortunately, a virus must run its course, which
usually lasts from 7 to 14 days. Antibiotics only work against
bacteria, not viruses. Therefore, they do not work for colds or
the flu.
Most doctors advise that the best way to treat a cold or the flu
is by drinking plenty of fluids and getting some rest. But most
patients take over-the-counter medications. Do they work?
Don't give cough and cold medications to infants or young
children
Although over-the-counter (OTC) medication for colds and flu are
popular, that doesn't mean they work, especially for children.
In January 2008, the Food and Drug Administration (FDA) advised
parents that OTC cough and cold medications should not be given
to children under the age of two because of the
potential risks. This followed an announcement three months earlier
by the companies that make these products, saying they would stop
selling or promoting their use for children under two.
Both decisions were the result of criticisms by influential doctors
and medical associations, protesting the marketing and widespread
use of OTC pediatric cough and cold medications for young children
under the age of six. However, when experts had
previously been asked by the FDA to provide advice about these
medications, the experts had concluded that there was no good
evidence that these medications work for children under the age
of 12.
The FDA continues to review the research and plans to make an
announcement in the spring of 2008 about whether these medications
are safe and effective for children ages 2 through 11. Meanwhile,
the instructions for OTC pediatric cough and cold medications
recommend that the products not be used by children under two
years of age except under the guidance of a medical professional.
However, companies have continued to market these products to
parents of infants and young children, with packaging that features
images of young children as well as droppers to aid administration
of “infant formulations.” As a result, these medications are widely
used for infants and young children even though there is no
evidence that these products are safe or effective for
children under the age of six. They seem to be safe for children
ages 6-11, but may not work.
We agree with the doctors and medical associations that asked
that the FDA require studies of the effects and safety of these
medications in young children; a public education campaign to
inform parents of the lack of evidence for use of OTC cough and
cold medications in young children; and labeling to make it clear
to consumers that these products have not been found safe or effective
in young children.
If the medications don't work, why sell them? Since many children
under 6 are harmed by confusion about the proper use of these
medications, and there is no evidence that they work for children
that age, the FDA should put large, clear warnings on the label
and on any advertisements.
The situation is different for children between 6 and 12, because
the medications don't seem to do much harm, but we don't know
if they have any benefit. Most likely, the FDA will ask for better
studies to find out if these medications do more good than harm for
children under the age of 12. Meanwhile, the FDA will have to
decide if the medications can continue to be sold, and if so,
should the labels say that these medications may not work for
children under 12. Some doctors have expressed concern that parents
want cold medications for their children, and that many parents will
give adult versions of the medications to their children even
if the label says not to. That seems to imply that parents are
too stupid to follow directions. But, that is not a good reason
to allow the continued sale of medications that don't work.
Do these cough and cold medications work for adults? The studies
are not very good for adults either, but some of these medications
seem to work, while others don't. And, combination cold medications that
treat many different symptoms are rarely a good choice—it makes
more sense to treat only the symptoms that are bothering you.
Antibiotics don't work
Antibiotics are often prescribed for colds or the flu, even though
they do not work. According to the Centers for Disease Control
and Prevention (CDC), about half of the 100 million antibiotic
prescriptions written annually in the U.S. are unnecessary. The
American College of Physicians reports that "using antibiotics
too much, too often, or not finishing a prescription reduces their
effectiveness and can cause a problem called antibiotic resistance."
Antibiotic resistance is when bacteria are exposed to antibiotics
and are able to survive by making genes that are resistant to
the antibiotic. When harmful bacteria with resistant genes make
us sick, antibiotics are no longer an effective treatment.
To cope with the decreasing effectiveness of some antibiotics,
new antibiotics have been developed that bacteria are not yet
resistant to. However, these newer antibiotics, such as Levaquin
and Cipro, are very expensive and have substantial risks and side
effects compared to older antibiotics such as amoxicillin.
The bottom line: antibiotics should not be used for colds, flu, or other viruses. Generally, older antibiotics should be tried first, since they are safer, less expensive, and often just as effective.
The American College of Physicians released guidelines for prescribing antibiotics in conjunction with the CDC, the American Society of Internal Medicine, the American Academy of Family Physicians, and the Infectious Disease Society of America.
These measures are directed at both doctors and consumers in order to lower rates of unnecessary prescriptions for antibiotics. Although it may seem unusual to target patients in addition to physicians, doctors claim that many patients feel entitled to a prescription when they visit the doctor. By educating the public that not receiving medication does not mean substandard care, the American College of Physicians hopes to reduce the pressure on physicians to write unneeded prescriptions.
The American College of Physicians’ Consumer Guidelines for Antibiotics:
- Don’t insist on antibiotics for yourself or your children.
- Ask your doctor, "Is this antibiotic really necessary?"
- Take only with a doctor’s instructions—don’t take antibiotics
left over from old prescriptions, given to you by friends or family,
or purchased abroad without a prescription.
- Prevent infections by washing hands thoroughly. Wash fruits
and vegetables thoroughly. Avoid raw eggs and undercooked meats—especially
ground meats.
- Keep immunizations up-to-date—especially for influenza and pneumonia
if you are a senior citizen or have a chronic illness.
- Finish each antibiotic prescription—even if you feel better. If you don’t finish the prescription, some resistant bacteria may stay with you and multiply, requiring a different—and most likely stronger—antibiotic when the infection returns weeks later.
The risks of medication can outweigh the benefits
The new concerns about OTC medication for children are just the
latest warning that popular over-the-counter medications can be
dangerous. In 2001, the FDA ordered that all medications containing
phenylpropanolamine (PPA) be removed from the shelves
because of evidence that taking PPA increases the risk of stroke.
FDA’s decision was made after a study at Yale Medical School showed
an association between PPA use and stroke in women using the medicine
to lose weight. Men may also be at risk.
Although medicines containing PPA should no longer be available at the store, it is possible that you may have medicines containing PPA in your medicine cabinet. To be safe, those medicines should be discarded. They include:
Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements
Acutrim Maximum Strength Appetite Control
BC Allergy Sinus Cold Powder
BC Sinus Cold Powder
Dexatrim Extended Duration
Dexatrim Gelcaps
Dexatrim Vitamin C/Caffeine Free
Dimetapp Cold & Allergy Chewable Tablets
Dimetapp Cold & Cough Liqui-Gels
Dimetapp 4-Hour Liqui-Gels
Dimetapp 4-Hour Tablets
Dimetapp 12-Hour Extentabs Tablets
Tavist-D 12 Hour Relief of Sinus & Nasal Congestion
Triaminic DM Cough Relief
Triaminic Expectorant Chest & Head Congestion
Triaminic Syrup Cold & Allergy
Triaminic Triaminicol Cold & Cough
Some of the medications that used to contain PPA are sold under the same name today, but no longer contain PPA. If you have old versions of any of the following medicines, check to see if they contain PPA. If they do, throw them out.
Alka-Seltzer Plus Children’s Cold Medicine Effervescent
Alka-Seltzer Plus Cold Medicine (cherry or orange flavor)
Alka-Seltzer Plus Cold Medicine Original
Alka-Seltzer Plus Cold & Cough Medicine Effervescent
Alka-Seltzer Plus Cold & Flu Medicine Effervescent
Alka-Seltzer Plus Cold & Sinus Effervescent
Alka-Seltzer Plus Night-Time Cold Medicine Effervescent
Comtrex Deep Chest Cold & Congestion Relief
Comtrex Flu Therapy & Fever Relief Day & Night
Contac 12 Hour Cold Capsules
Contac 12 Hour Cold Caplets
Coricidin ‘D’ Cold, Flu & Sinus
Dexatrim Caffeine Free
Dimetapp DM Cold & Cough Elixir
Dimetapp Elixir
Naldecon DX Pediatric Drops
Permathene Mega-16
Robitussin CF
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