Colds and the Flu - Medications

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Timing and Effectiveness of the Vaccine. Ideally, everyone should be vaccinated every October or November. However, it may take longer for a full supply of the vaccine to reach certain locations. In such cases, the high-risk groups should be served first.

Antibodies to the flu virus usually develop within 2 weeks of vaccination, and immunity peaks within 4 - 6 weeks, then gradually wanes.

• Children younger than 9 years of age, who have not been previously vaccinated or received only 1 dose the previous year should be given 2 vaccine doses, spaced 4 weeks apart.
• It should be noted that if an individual develops flu symptoms and is accurately diagnosed in time, vaccination of the other members of the household within 36 - 48 hours affords effective protection to those individuals, according to a 2004 Canadian analysis of multiple studies.

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In healthy adults, immunization typically reduces the chance of getting the seasonal flu by about 70 - 90%. The current flu vaccines may be slightly less effective in certain patients, such as the elderly and those with certain chronic diseases. Some evidence suggests, however, that even in people with a weaker response, the vaccine is usually protective against serious flu complications, particularly pneumonia. Some evidence suggests that among the elderly, a flu shot may help protect against stroke, adverse heart events, and death from all causes.

Everyone aged 6 months and over should get a flu vaccine; the only exception is for those who are allergic to the vaccine. It is especially important in the following groups, who are at a high risk for complications from the flu:

• People who are 50 or more years of age
• People who are 6 to 49 months of age
• People who have chronic lung disease, including asthma and COPD, or heart disease
• People who are 18 years old or younger AND taking long-term aspirin therapy
• People who have sickle cell anemia or other hemoglobin-related disorders
• People who have kidney disease, anemia, diabetes, or chronic liver disease
• People who have a weakened immune system (including those with cancer or HIV/AIDS)
• People who receive long-term treatment with steroids for any condition
• Women who are pregnant or plan to become pregnant during the flu season. Women who are pregnant should receive only the inactivated flu vaccine. (Vaccinations should usually be given after the first trimester. Exceptions may be women who are in their first trimester during flu season, because their risk from complications of the flu is higher than any theoretical risk to the baby from the vaccine)

Negative Effects

Possible side effects of the flu vaccine include:

• Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs.
• Soreness at the Injection Site. Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 or 2 days afterward.
• Flu-like Symptoms. Some people actually experience flu-like symptoms, called oculorespiratory syndrome, which include conjunctivitis, cough, wheeze, tightness in the chest, sore throat, or a combination. Such symptoms tend to occur 2 - 24 hours after the vaccination and generally last for up to 2 days. It should be noted that these symptoms are not the flu itself but an immune response to the virus proteins in the vaccine. (Anyone with a fever at the time the vaccination is scheduled, however, should wait to be immunized until the ailment has subsided.)
• Guillain-Barre Syndrome. Isolated cases of a paralytic illness known as Guillain-Barre syndrome have occurred, but if there is any higher risk following the flu vaccine, it is very small (one additional case per 1 million people), and does not outweigh the benefits of the vaccine. Guillain-Barre syndrome resolves in most cases, but recovery is slow.

There has been some question concerning influenza vaccinations because of reports that these vaccines may worsen asthma. Recent and major studies have been reporting, however, that the vaccination is safe for children with asthma. It is also very important for these patients to reduce their risk for respiratory diseases.

Avian Influenza Vaccine

The FDA approved the first vaccine for humans against H5NI influenza virus in April 2007. The vaccine, which is made from a human strain of the virus, could be used in people ages 18 - 64 to prevent the spread of the virus from human to human. The vaccine requires two doses, given about a month apart. It will not be sold commercially, but instead is being purchased by the U.S. government to be stockpiled and distributed to public health officials in the event of an outbreak of avian flu. The vaccine led to the development of antibodies in 45% of those who received the higher dose studied. The most common side effects reported were pain at the injection site, headache, and muscle pain. Research on the vaccine is continuing.

Who Needs Antibiotic

How Is Strep Throat Treated? Strep throat infections require antibiotics. Antibiotics prevent a serious complication called rheumatic fever, which can result in permanent damage to the heart. Fortunately, this complication rarely occurs in United States anymore. Antibiotic treatment of strep throat will almost always prevent this complication. In addition, antibiotics shorten the recovery time from strep throat.

The following antibiotics are generally used to treat strep throat:

• Penicillin is usually the antibiotic of choice unless the patient is allergic to it. A full 10 days of treatment may be necessary to clear the infection. Amoxicillin, a form of penicillin, is proving to be effective when taken in a single daily dose for 10 days.
• Macrolide antibiotics. Erythromycin is known as a macrolide antibiotic and is an appropriate choice for patients with penicillin allergies. A 10-day regimen is needed to clear the infection. Another macrolide, azithromycin, can be given as a single daily dose and is effective in 5 days. It is expensive, however, and bacterial resistance to macrolides is growing, so it should not be given as a first choice.
• Cephalosporins are also very effective in eradicating the bacteria.

Antibiotics are very often inappropriately prescribed for non-strep sore throats. Studies indicate that fewer than half of adults and far fewer of the children with even strong signs and symptoms for strep throat actually have strep infections.

Parents should be comforted that a delay in antibiotic treatment while waiting for lab results does not increase the risk that the child will develop serious long-term complications, including acute rheumatic fever. If a patient is severely ill, however, it is reasonable to begin administering antibiotics before the results are back. If the culture is negative (there is no evidence of bacteria), the doctor should call the family to make certain the patient stops taking the antibiotics and any remaining pills are discarded.

Children who have a sore throat and who have had rheumatic fever in the past should receive antibiotics immediately, even before culture results are back. Children with a sore throat who have a family member with strep throat or rheumatic fever should also receive immediate antibiotic treatment.

Antibiotic Resistance

The intense and widespread use of antibiotics is leading to a serious global problem of antibiotic resistance. The inappropriate use of powerful newer antibiotics for conditions such as colds or sore throats poses a particular risk for the development of resistant strains of bacteria. For example, the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in people who have no known risk factors. (MRSA causes sometimes-fatal skin infections.) In 2006, rates of Neisseria gonorrhoeae resistance to the fluoroquinolone antibiotics family exceeded 10%. The CDC no longer recommends treating gonorrhea infections with fluoroquinolone first.

When Antibiotics Are Needed for Upper Respiratory Infections.

Antibiotics do not affect viruses and, in healthy individuals, these drugs are not necessary or helpful for influenza or colds, even with persistent cough and thick, green mucus. In one disturbing study, antibiotics were prescribed for nearly half of children who went to the doctor for a common cold.

Antibiotics may be required for upper respiratory tract infections only under certain situations, such as the following:

• Patients, particularly small children or elderly people, who have medical conditions that put them at high risk for complications from any respiratory tract infections, may sometimes be given antibiotics.
• Patients with severe sinusitis that does not clear up within 7 days (some experts say 10 days) and whose symptoms include one or more of the following: green and thick nasal discharge, facial pain, or tooth pain or tenderness. [For more information, see In-Depth Report # 62: Sinusitis.]
• Some children with middle ear infections, although experts differ on who will benefit. Some experts recommend that only children under the age of 2 years should be treated with antibiotics, and children over 2 should be treated on a case-by-case basis. [For more information, see In-Depth Report # 78: Ear Infections.]
• Patients with strep throat or severe sore throat that involves fever, swollen lymph nodes, and absence of cough. (Strep throat makes up only 10 - 15% of all sore throat cases.)

Patients at Highest Risk for Infection with Resistant Bacteria Strains. Some patients are at greater risk for developing an infection resistant to common antibiotics. At this time, the average person is not endangered by this problem. Risk factors include:

• Very old or very young age
• Exposure to patients with drug-resistant infection
• Hospitalization in intensive care units
• History of an invasive surgical procedure
• Staying in the hospital
• Prolonged course of antibiotics, particularly within the past 4 - 6 weeks
• Serious wounds
• Tubes down the throat, catheters, or intravenous (I.V.) lines
• Immunosuppression

Children at higher risk for antibiotic resistance are those who attend day care, who are exposed to cigarette smoke, who were bottle-fed, and who had siblings with recurrent ear infections.

What the Health Care Community Is Doing. Prescribing antibiotics only when necessary is the most important step in restoring bacterial strains that are susceptible to antibiotics. Encouraging studies are reporting that inappropriate antibiotic prescriptions are on the decline. Prescriptions for other common respiratory infections, such as otitis media, sore throat, acute bronchitis, and colds and flus have been decreasing.

What Patients and Parents Can Do. Patients and parents can also help with the following tips:

• Use home or over-the-counter remedies to relieve symptoms of mild upper respiratory tract infections.
• Realize that antibiotics will not shorten the course of a viral infection. It is important for patients and parents to understand that although antibiotics may bring a sense of security, they provide no significant benefit for a person with viral infection, and overuse can contribute to the growing problem of resistant bacteria.
• Don't pressure a doctor into prescribing an antibiotic if it is clearly inappropriate. The doctor very often will give in.
• If a child needs an antibiotic, ask the doctor whether it is appropriate to use high-dose short-term antibiotics, which may lower the risk for developing resistant strains.
• If an antibiotic is prescribed, take the full course, even if you feel better before finishing it.

Review Date: 01/29/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).