Cold and flu: first aid and when antibiotics do not help

The first cold week of October always provokes the same conversation. This year it was opened by a man around fifty who placed an empty blister pack on the counter and said: give me some of this, it fixed me in three days last winter. The blister carried the name of an antibiotic. I asked who had prescribed it back then. Well, nobody, my brother had left it at my place. That exact moment is where half the trouble with flu in this country begins: not the virus, but the habits around it.

This article is about the other half: what really helps when you catch it. How the common cold differs from the flu, why an antibiotic against a viral infection is like a key to somebody else's door, what relieves the symptoms in the first 48 hours and at which signs you stop self-treatment and see a doctor.

The common cold arrives on tiptoe. First a tickle in the throat, then a runny nose and sneezing, the temperature is low or absent, and most of the time the person keeps functioning, however grumpy. The culprits are over two hundred different viruses, most often rhinoviruses (CDC). It is annoying, but it usually passes on its own within a week to ten days.

The flu does not tiptoe, it strikes hard. People often remember the hour: fine in the morning, by noon a fever of 38.5 degrees and rising, aching muscles and joints, a pounding headache and exhaustion that pins you to the bed. The cough is dry and irritating. The cause is the influenza virus. Flu A, B and C are the types of true flu (influenza), and one of its complications, pneumonia, is the reason it sends people to hospital every winter (WHO). And what is the difference between flu A, B and C: 1. Flu type A is the most aggressive type, it affects humans and animals, mutates quickly and causes large epidemics. 2. Flu type B affects only humans, mutates more slowly than type A, but also causes seasonal epidemics that can run severe in children and the elderly. 3. Flu type C affects humans and rarely animals and runs a very mild course, usually like a common cold. And remember: with a cold you sneeze and grumble, with the flu you turn into a rag and lie down.

Antibiotics kill bacteria or stop them from multiplying. Colds and flu are caused by viruses, and viruses have no cell wall or metabolism of their own for the antibiotic to attack. Antibiotics kill bacteria by destroying their cell wall or membrane, or they stop the growth and multiplication of bacteria so the immune system can remove them. An antibiotic against the flu is like a key to somebody else's door: however fine the key, the door will not open. It will not shorten the illness, will not soften it and will not protect the people around you.

There is, however, a price we all pay. Every unnecessary course of antibiotics trains bacteria to resist it, and resistance is already measured in human lives: ECDC estimates attribute over 35,000 deaths a year to it in the EU. Bulgaria is among the countries with the highest outpatient antibiotic consumption in the Union (ECDC/ESAC-Net). That is exactly why antibiotics in Bulgaria are fully prescription-only by law: a pharmacy that dispenses them without a prescription breaks the law. The decision whether an antibiotic is needed at all is made by a doctor, after an examination.

Against the virus itself, nothing special is done in a healthy person: the body manages on its own, and our job is to help it and to control the symptoms. The foundation is rest and fluids, far more than you feel like drinking. For fever and aches, paracetamol or ibuprofen work, taken according to the instructions in the leaflet and without combining several products with the same ingredient, because most combination flu powders already contain paracetamol. That is the most common mistake I see: a paracetamol tablet on top of a paracetamol powder.

For the nose, saline solution is the first thing, not the last: rinsing removes the virus and the secretion mechanically. And the sprays with xylometazoline or oxymetazoline unblock quickly, but they are used for no more than 5 to 7 days, because after that the mucosa gets used to them and the blockage becomes chronic (so-called rhinitis medicamentosa). For the throat: warm drinks, lozenges, and honey has data showing it soothes cough in children over 1 year and in adults (Cochrane). Honey is not given to children under 1 year because of the risk of botulism (an extremely serious illness that attacks the nervous system).

A true anti-flu medicine also exists (oseltamivir), but it is prescription-only and makes sense only when started within the first 48 hours of symptoms, mainly for people in the risk groups. That is why with a severe onset, especially in an elderly or chronically ill person, you do not wait a week: the doctor is seen within the first day or two. Many pharmacies now also stock rapid flu tests that show within minutes whether influenza (flu) is involved.

Vitamin C started at the first sneeze is the most persistent and widespread claim circulating. And as the saying goes: yes, but no: Cochrane has checked it: intake begun after the symptoms appear has no consistent effect on the common cold. I write in detail about what vitamin C really does and when in the article on vitamin C.

A glass of brandy does not cure either: alcohol dehydrates and worsens sleep, and those are the two things recovery needs most. Sweating under three blankets does not sweat out the virus, it only increases fluid loss. And cold weather by itself does not cause a cold; I covered that in the article on the air-conditioner myth.

Home treatment has clear limits. You go to the doctor without waiting, with: temperature above 39 that does not come down, or temperature lasting more than 3 days; shortness of breath, chest pain, confusion, severe dehydration. Especially insidious is the scenario of getting better and then being hit again: improvement for a day or two, followed by a new, higher temperature with cough. That is the typical sign that a bacterial infection has developed after the virus, and this is the moment when the doctor decides whether an antibiotic is needed.

For some people with flu symptoms, you do not wait at all: pregnant women, adults over 65, people with asthma, diabetes, heart and kidney disease, suppressed immunity, as well as small children. For them the decision is made by a doctor from the very start, because complications in these groups come quickly. Diagnosis and therapy are determined by a doctor; my job is to prepare you for that conversation.

Against the flu there is one prevention with a proven effect: the annual vaccine. Its composition is updated every year according to the strains the WHO expects to circulate. Protection builds up over about two weeks, so the sensible window is October and November, before the season peaks. There is no 100% certainty that you will not fall ill, but even if it has not fully protected you from infection, you will have a milder illness and end up in hospital less often (CDC).

The vaccine cannot give you the flu: it contains no live virus. If you fell ill days after it, you were most likely already in the incubation period of something else circulating in autumn. For the risk groups the vaccine is strongly recommended and in many regions it is covered or preferred through your GP, so ask yours.

An antibiotic protects against complications. No, it is not an insurance policy. A bacterial complication is treated when it appears and when a doctor confirms it, while an antibiotic taken blindly only trains resistance.

The flu is just a stronger cold. Different viruses, different course, different risk. A cold annoys you for a week; the flu can send you to hospital.

It passed in two days, so it was the flu. True flu rarely passes in two days. It was more likely one of the hundreds of other autumn infections, for which the same rule applies: symptomatic care, not an antibiotic.

This article was written by Donka Arabadzhova, Master of Pharmacy, and confirmed by the following sources: Centers for Disease Control and Prevention (CDC), seasonal flu and common cold materials; World Health Organization (WHO), influenza fact sheets; European Centre for Disease Prevention and Control (ECDC), antimicrobial consumption and resistance reports (ESAC-Net); Cochrane Database of Systematic Reviews, reviews on honey for acute cough (Oduwole and colleagues, 2018) and on vitamin C for the common cold (Hemilä and Chalker); Bulgarian Medicinal Products in Human Medicine Act, prescription status of systemic antibacterial medicinal products.