Keep spreading it around….some thoughts on cold and flu treatments

I think it is irresponsible to encourage someone who may well have an infectious illness like influenza to take a tablet so they can feel better, return to school and infect a classroom of small children.

Reckitt Benckiser (Australia) Pty Limited the markers of Nurofen Cold and Flu is not the only Pharmaceutical manufacturer who puts profits ahead of common sense and evidence in their marketing,

Pfizer Consumer Healthcare sell the same message at http://www.dimetapp.com.au/tvc.html. Only in this add its okay to contaminate a public swimming pool with your virus!

Johnson & Johnson Pacific Pty Limited would have you take Coldral to keep you soldiering on …. to pass on the cold to all your friends. Go Audrey!

South Australia’s Health Department advises the best way to slow down the spread of influenza is to get vaccinated.  The Influenza Management Guideline for Emergency Departments and General Practice suggests isolation and face masks whilst being assessed. Furthermore, if the patient doesn’t require admission to hospital encourage the patient to stay at home and practice good hand hygiene and cough etiquette. If going outside house, strongly encourage the patient to keep at least 1 metre away from other people and to use cough etiquette. Patting kids on the head in the playground is neither. The NSW Health Department specifically recommends symptomatic people should not attend school, child care, work or public gatherings.

Most people with influenza recover with rest, drinking plenty of fluids and use of paracetamol for the relief of pain and fever.

There are specific prescription-only drugs that may be useful in influenza. These are not antibiotics; antibiotics are not useful for treating viral illnesses such as influenza.

Amantadine and rimantadine are effective only against the influenza A virus and work by by blocking viral replication inside the host cell.  However, they are associated with several toxic effects and with the rapid emergence of drug-resistance. Oseltamivir and zanamivir act against influenza A and B by preventing influenza viral release from infected cells. They work by blocking neuraminidase  and are less likely to cause resistance or serious adverse effects. Because replication of influenza virus reaches its peak within 24 to 72 hours after the onset of the illness, antiviral drugs are needed to be used as early as possible and within the first 48 hours of symptom onset. When initiated within 36 to 48 hours of the onset of symptoms, zanamivir shortened the time until the alleviation of symptoms by 1 to 1.5 days compared with a placebo! Back to work Tuesday rather than Wednesday!!

Is there any clinical evidence that any of these over the counter well marketed do any good? Has Reckitt Benckiser, Pfizer, Johnson &  Johnson or any number of Pharmaceutical companies conducted and published randomised clinical trials proving benefit of these products? It’s not as if there is a lack of suitable subjects.

In a similar vein, Cochrane has shown there is no good evidence for or against the effectiveness of OTC medicines in acute cough. Studies often showed conflicting results with uncertainty regarding clinical relevance.

And if these products don’t do any good can they do harm? Well yes and particularly in children. Sarfstein et al argue in the NEJM (Over the Counter but No Longer under the Radar) that there is no evidence of effectiveness particularly in children and documented harm. Cardiac arrhythmias, hallucinations, convulsions, altered consciousness and encephalopathy are some of the severe side effects. In the US, an FDA review implicated symptomatic cold and flu treatments in 123 deaths of children under six years of age. In Australia the TGA suggested in November 2012 that children under six should not be given these medications.

After the rant how about a bit of science…….

A glance at how the flu-virus interacts with our cells makes it understandable that finding a cure is going to be tricky!

1741-7015-10-104-1Anti-influenza drugs and their biological targets. The relevant viral proteins (color-coded) and old and new drugs targeting them are shown (not drawn to scale). The genomic ribonucleoprotein complex is shown as tightly coiled. Influenza viral RNA synthesis occurs in the infected host nucleus using this ribonucleoprotein as a template, while translation occurs in the cytoplasm. Neuraminidase (NA) and the drug candidate, Fludase, cleave the sialic acid receptor on the cell membrane, as indicated by the cutting scissors. Nonstructural proteins (only NS1 is shown) are not packaged in mature virions. Diverse viral products activate an inflammatory response that can be quelled by the use of anti-inflammatory treatments, such as non-steroidal anti-inflammatory drugs. Potential future drug regimens, targeting influenza-relevant cellular functions, are shown at the bottom. (Influenza virion image credit: Dan Higgins and Doug Jordan, CDC Public Health Photo Library, image #11822). HA: hemagglutinin; IFN: interferon; NA: neuraminidase; NS: nonstructural protein; RNP: ribonucleoprotein.  Barik BMC Medicine 2012 10:104   doi:10.1186/1741-7015-10-104

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