COUGHS, COLDS AND INFLUENZA – Dr D Weston Allen M.B,B.S, F.R.A.C.G.P.



Jim: “Doc, I just want some antibiotics for the ‘flu.” The doctor obliged and bulk-billed Jim for a quick consult. Two days later, Jim returned worse than before for stronger antibiotics. Despite spending over $40 at the chemist, Jim took longer to recover than if he had never seen the doctor. Why? Antibiotics don’t kill flu or other viruses, but can actually make things worse by weakening part of the body’s immune system and by killing harmless bacteria that compete with those that cause disease. So, you are actually more likely to get pneumonia by taking an antibiotic to prevent it! Overuse of antibiotics has also bred many resistant bugs.

INFLUENZA Two prescription anti-viral medications [Relenza and Tamiflu] are effective for influenza, significantly reducing its severity and duration (usually 1-2 weeks). But you must commence them within 48 hours of the onset of symptoms, they cost around $50, and they don’t work for colds or other viruses. Most people don’t know how to tell the common cold from the much less common influenza, so refer to colds as a ‘touch of the ‘flu’! How do you know when you have influenza? It comes on suddenly, usually with chills and shivers, fever, sore eyes, headache, sore muscles and sore throat, then a productive cough as the virus quickly spreads to the lungs, and increasing weakness and fatigue. There may be nausea and vomiting, but no diahhroea. If it comes on with a runny nose or sneezing, it is probably NOT the ‘flu. It is therefore important for the doctor to take a careful history and do a thorough examination to make a correct diagnosis.

COMMON ‘HEAD COLDS’ usually come on with a blocked or runny nose or sneezing (rhinitis), followed by a sore throat, mild fever and malaise, and maybe a cough or laryngitis, and it lasts about a week. It is usually due to a rhinovirus, a coronavirus, or a parainfluenza virus. The adenovirus causes a more severe illness, usually with conjunctivitis, laryngitis and enlarged lymph glands. Glandular fever (caused by the Epstein-Barr virus) affects the throat but not the nose. The respiratory syncitial virus is often associated with bronchitis, or bronchiolitis in infants. None of these viruses are killed by any known medication, but are destroyed by the body’s immune system, and by a fever, which does more good than harm unless it goes above 39 OC. Otherwise, keep warm and rested, drink copious quantities of water or warm drinks, and avoid excessive sweet food or drink – even the sugar in fruit juice inhibits white cell action. Vitamin C (500-1,000mg three times a day) for 4-5 days has been shown to hasten recovery, but not to prevent colds or ‘flu’s. Zinc lozenges may also help. Plain steam inhalations several times a day are the best thing for cough. Menthol, eucalyptus, Friars Balsam etc. all irritate the mucous membranes and make matters worse, so don’t add these to the steam.

RHINITIS is almost never bacterial and, even when the nasal discharge turns thick green or yellow and bacteria are grown from a nose swab, antibiotics do not hasten recovery. In allergic rhinitis (or ‘hay fever’, where there is actually no fever, or sore throat), anti-inflammatory nose sprays (e.g. Rhinocort, Beconase) or antihistamines (e.g. Telfast, Claratyne, Polaramine) are effective in relieving symptoms. But these may actually delay recovery of a head cold by making the mucous more viscid (sticky) and more difficult to expel from the sinuses. Decongestant nose drops or sprays (e.g. Drixine, Otriven) are preferable, but they must not be used for more than 5 days, or they will actually block the nose. It is better and far cheaper to use a saline spray (Nyal Saline or FESS, which you can make by adding a teaspoon of salt and half a teaspoon of bicarbonate of soda to 500ml of boiled water). Spraying it up the nose every few hours helps clear the nose.

SINUSITIS is due to infection of the sinus cavities, causing fever, facial pain and tenderness, or headache and sometimes toothache. Studies show that 70% of cases of acute sinusitis get better in a week with or without antibiotics, which should only be prescribed if there is severe facial pain or swelling, a temperature of 39OC or above, or no improvement after 10-14 days. Hot packs to the sinuses and nasal decongestants often help.

OTITIS MEDIA or middle ear infection, due to obstruction of the Eustachian tube and trapping in the middle ear of germs from the back of the nose, is very common in young children. Whereas 98% of Australian doctors prescribe antibiotics for this condition, only 31% of Dutch doctors do, and the outcome in Holland is no worse than in Australia. Antibiotics benefit only one in case in seven, and the earache goes, on average, only 8 hours sooner with antibiotics. The reason for this is that otitis media is mostly caused by either a virus or drug-resistant bacteria. On the other hand, one in seven children prescribed antibiotics have vomiting, diahhroea or a rash, so there is a trade off between the benefits and side effects. Decongestants and antihistamines do not help and may make matters worse by making the mucous gluey. Otitis media with effusion (‘glue ear’) frequently follows an acute infection, but clears without treatment within a month in 50%, within two months in 80% and by three months in 90% of cases. Milk does NOT cause mucous, unless you are allergic to it, but a low sugar diet may help. Only after three months without improvement should antibiotics be given, for up to a month, before consideration is given to inserting grommets to ventilate the middle ear.

PHARYNGITIS or acute sore throat is mostly viral, and invariably viral if there is also a cough and/or nasal symptoms. The only important bacterium that causes sore throat (Streptococcus pyogenes) is more common in children aged 5-15, and quite rare after the age of 45. In the vast majority of cases, even this bacterial pharyngitis gets better by itself nearly as fast without antibiotics. Australian health authorities now advise antibiotics only for exudative (pustular) pharyngitis or tonsillitis with a fever over 38 OC, tender lymph glands in the neck and no cough. Antiseptic lozenges do not help and should be avoided. Gargling with warm salty water, or Difflam, may help and hot fomentations (towels, ‘wheat heat’ etc.) often provide good relief.

EPIGLOTTITIS is now a rare but deadly bacterial disease of young children; usually those unimmunised or inadequately vaccinated against HIB. Any infant or young child with a high fever, difficulty breathing or talking, preferring to sit than lie down, often drooling saliva from an open mouth, should be rushed to the nearest children’s hospital.

CROUP (the barking cough of a child with subglottic oedema) is always viral and usually mild and self-limiting. Rest is essential. Steam does not help. A dose of cortisone is effective, even in mild cases, but antibiotics do nothing. If breathing is difficult and noisy, admission to hospital is essential.

BRONCHITIS is more often viral than bacterial, especially when associated with rhinitis and/or a sore throat, and so antibiotics don’t usually help. It is important to differentiate viral bronchitis from asthma, which may be triggered by a virus, and from several bacteria-like organisms (mycoplasma and chlamydia pneumoniae) which cause ‘walking pneumonia’, which can be serious in the elderly and responds only to certain antibiotics. This usually comes on over several days with a dry cough that becomes loose, a mild fever and increasing malaise. There can be sore throat and earache but seldom any nasal symptoms. Because these germs do not grow in sputum cultures and it can take 10 days for blood testes to turn positive, it is not easy to diagnose in the early stages. Unlike viral respiratory tract infections, which manifest within a few days of contracting them, these organisms take several weeks to incubate, so this can provide a clue if family members become ill weeks (rather than days) apart. Your doctor will also want to know when the cough is worse, whether it is triggered by cold air, laughing or lying down, aggravated or relieved by steam. Thick colored sputum is more often viral than bacterial.

CONCLUSION It is therefore essential that, if you do decide to see your doctor, you give an accurate and chronological account of your symptoms, your recent contacts, and what treatments you have used. Above all, don’t expect a quick script.