Influenza treatments

It usually happens in winter: You get a fever that makes you feel chilly, you’ve got the flu. It is not surprising that the medical term for the flu, “influenza”, comes from the Italian phrase, “influenza di freddo” – the influence of the cold. But influenza is not a common cold. For people who are otherwise healthy, influenza strikes hard and fast, and the worst is usually over within a week. You could be tired and coughing for a while longer. But for the very young, people with some illnesses and people over the age of 60, complications of influenza can become very serious. Influenza is caused by viruses that can spread very quickly.

If you are ill with what you think might be influenza, you need to do what you can to prevent other people getting infected too. You can read more about this in our fact sheet (URL: http://www.informedhealthonline.org/index.319.en.html) on protecting yourself and your family from influenza and similar viruses. People with influenza are already infectious one day before they get sick, while they are sick and for about a week afterwards. Treatments for influenza do not make people less contagious to others.

How can I tell if I have influenza and what complications could there be?

It can be hard to tell the difference between colds, influenza and other flu-like diseases. Most of the time when people think they have influenza, they actually have some other kind of respiratory virus (a virus of the airways or breathing system). The symptoms of influenza are very like the symptoms of the common cold. You can have a fever, headache, blocked and/or runny nose, and aches and pains all through your body. You generally feel very ill. A very bad cold can feel like this, but a cold usually comes on gradually. Influenza hits harder - you feel very sick, very quickly. You can read more about typical flu symptoms here (URL: http://www.informedhealthonline.org/index.173.en.html) .

Some people are at much higher risk of getting very sick or going on to have complications like pneumonia – a serious lung infection. This includes babies and very young children, people with lung or immune system diseases and people who are over the age of 60. A less serious but quite common complication is sinusitis, where the empty spaces in the head around the nose get full of infected fluid and cause pain and a blocked nose. Babies and young children will often get a middle ear infection (called acute otitis media) when they have any kind of respiratory infection. That is because these infections travel quite quickly from the back of the nose and throat to a baby’s ears.

Are there drugs that can help if I or someone in my family has the flu?

If you already feel very sick with influenza, the worst of your symptoms will probably be over in a few days. There are antiviral influenza drugs that could reduce the period of illness from influenza by up to one day. But they have to be prescribed by a doctor, have to be taken within two days of the start of symptoms and they have adverse effects. If you are several days into influenza by the time you realise you have it, they will not help.

Taking influenza drugs if someone close to you definitely has influenza could prevent you becoming ill though. The most likely adverse effect for healthy people taking the latest influenza drugs is nausea. Nausea occurs in about 1 in 20 people who take this medication to prevent infection. At doses above 75 mg per day, a higher proportion of people could feel nauseous.

The newer flu drugs, oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza), cause fewer adverse effects than the “old” flu drugs. Those older drugs are amantadine (trade name Symmetrel) and rimantadine (trade name Flumadine). Rimantadine is not on the market in Germany. Amantadine is available as tablets and in suspension (liquid form). Oseltamivir comes in tablet and suspension form, and zanamivir comes in a powder that is taken using an oral inhaler (that is, inhaled through the mouth, not the nose). This medication is not licensed for use in babies under 1 year old, and zanamivir is not licensed for use in children under 5 years old. Following a number of reports of potential harmful effects, the US FDA is currently again investigating how safe it is for children to take this medication. There are two main groups of virus that cause severe influenza: influenza A and influenza B.  The older drugs only act against influenza A viruses, while the new drugs treat both A and B influenza viruses.

It is difficult to know for certain how often the drugs have adverse effects when people are using them to treat their influenza. This is because the adverse effects of the drugs are similar to the symptoms of the flu itself. You can read more about the research testing antiviral flu drugs in adults here (URL: http://www.informedhealthonline.org/index.322.en.html) .

Some people think that antibiotics will help. But antibiotics only work against bacteria and they do not work against flu viruses. In other words, they only help if you have a bacterial infection of the airways on top of the viral infection.

What about non-prescription options?

There is no strong evidence that drinking a lot of fluids, eating chicken soup or using other home remedies can help you recover faster. Paracetamol (acetaminophen) could help relieve discomfort and fever. Although there are many products sold to try to relieve coughs, colds and influenza, there is no strong proof that any of them are likely to help with influenza more than paracetamol.

You can read more about treatments for the common cold in our feature (URL: http://www.gesundheitsinformation.de/common-cold.240.56.en.html) .

What treatment options are there if there is an outbreak of new kinds of influenza?

If there is a big influenza outbreak or epidemic involving new kinds of viruses, like the swine or bird flu, the newer antivirals (Tamiflu and Relenza) are likely to be used both as prevention and treatment, although we cannot be certain how much they might be able to help. The most important and effective thing to do if there is an influenza epidemic is to lower your chance of either getting, or spreading, the virus. This means you need to:

• wash your hands often – you do not need special antibacterial soap or solution: plain water and normal soap is enough.
• keep your hands away from your face – the most likely way to become infected is by touching your mouth or nose after touching something with the virus on it.
• avoid drinking out of the same cups or bottles as other people.
• avoid touching other people’s hands, hugging or kissing other people while you are contagious.
• cover your nose and mouth when you cough or sneeze, ideally with a tissue.
• dispose of used handkerchiefs and tissues properly – do not leave them lying around for other people to touch, and wash your hands after touching them yourself. It is better to use tissues rather than handkerchiefs, and to throw them away immediately after use.

You can read more about protecting yourself from influenza in our fact sheet (URL: http://www.informedhealthonline.org/index.319.en.html) about respiratory viruses.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)