Both cold and flu are caused by viruses, so antibiotics (which fight bacteria) do not work. There are no treatments directed at colds specifically, but antiviral medication can be used to help treat the flu. Antivirals will decrease the duration of the flu by a day, so still, just like for colds, the flu treatment is symptom-driven.
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Antiviral drugs stop replication of the virus into the host’s body and may reduce complications. Most healthy people do not need these. They should only be used for extremely sick or high-risk patients. Ideally they would be administered within 48 hours of onset of symptoms. Just as with antibiotics, some patients develop resistance to some antivirals.
Two Examples of Antiviral Medications
1) Neuraminidase inhibitors (oseltamivir, zanamivir, peramivir). If antiviral treatment is needed, these are typically the first administered. Side effects include nausea, vomiting and diarrhea as well as behavioral changes, hallucinations and sleep problems. Here are examples of this type of medication:
- Oseltamivir (Tamiflu): pills or liquid taken twice a day for five days.
- Zanamivir (Relenza): mouth inhaler (not for use in patients with lung problems).
- Peramivir (Rapivab): intravenous onetime shot given by doctor.
2) Adamantenes (Amantadine and rimantadine). These are older drugs and recent influenza viruses have become resistant to them, so they are not used as commonly now.
There are a plethora of medications, both over-the-counter and prescription, that help treat cold and flu symptoms. These medications can have interactions with other medications yielding significant side effects, such as high blood pressure, fast heart rate, heart block, dizziness, trouble urinating, worsening glaucoma, visual problems, drowsiness, hyperactivity, kidney problems and stomach bleeding. Therefore it is important to discuss with your physician which cold and flu medications are right for you given other medications you may be taking. This includes over-the-counter cold and flu medications.
Certain antibiotics, such as macrolides and tetracyclines, might also help because of their anti-inflammatory effects. This may be why people feel better after taking an antibiotic, even though they likely have a viral infection.
Medications for Nasal Symptoms
1) Ipratroprium bromide nasal spray (Atrovent) is an anticholinergic and the best choice for sneezing and runny nose. It is available by prescription only. Side effects can be dry nose and mild nose bleeding.
2) Anthistamines, such as diphenhydramine, chlorpheniramine, doxylamine and clemastine, can also be helpful for sneezing and runny nose. Side effects include drowsiness and trouble urinating.
3) Decongestants, such as psuedoephedrine, phenylephrine and oxymetazoline, can be very effective at treating nasal and ear congestion. Side effects can be raised blood pressure and heart rate.
Fever, Aches, Cough
For fever, chills, aches and pains, medications like ibuprofen (Advil, Motrin), naproxen (Aleve) and acetaminophen (Tylenol) can be helpful. Check with your doctor before taking these medications because ibuprofen and naproxen can raise blood pressure, affect kidney function and cause stomach bleeding. Also, acetaminophen can affect the liver.
For coughs, most medications are not helpful. Clearing or “drying up” nasal drainage in the back of the nose and throat is the best method. If the cough is deep in the lungs, then an inhaler may be needed and a doctor should be seen.
The sheer quantity and combinations of medications can be mind-boggling, and most doctors do not know about all of the medications out there. The pharmacist can be helpful in choosing which over-the-counter medication is best to treat your symptoms.
Children can receive the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) only. Per the CDC and American Academy of Pediatrics, children can take oseltamivir if they are over two weeks old and zanamivir if they are 7 years or older.
Unfortunately, some medications that help adults have been found to be harmful in children. The FDA has recommended against the use of antihistamines, decongestants and cough suppressants and/or expectorants in children less than 6 years old. If your child is more than 6 years old, they may have less risk of harm, but may not show benefits. Warning: Never give aspirin to children less than 18 months of age.
The only recommendations for children with a cough are humidified air and honey (for children older than 1 year old). Warning: Never give children less than 1 year of age honey because they could develop botulism.
For younger children, saltwater spray with gentle suction is recommended for nasal secretions and congestion. This should be a store-bought, sterile solution of saltwater. If you want to make the solution at home, be sure to ask your pediatrician what is the correct ratio of salt to water and how to properly sterilize the water.