COLDS & FLU
> cent of those questioned believed that they would have a faster resolution of their cold or flu with an antibiotic – despite the fact that antibiotics have absolutely no effect on viral infections.
this lack of information has led to a dramatic rise in antibiotic resistance, which is now recognised as a global health crisis and which poses the greatest threat and challenge to public health in the modern age. Every pharmacist knows that it is a major priority to reduce the inappropriate use of antibiotics in practice (it’s estimated that 74 per cent of antibiotics used in the UK are prescribed in general practice), so it’s vital that you endeavour to reduce inappropriate use by educating your patients as to exactly how antibiotics work, and about other ways in which they can manage their own symptoms.
Reassuring a patient that, with a little self help and over-the-counter medication, they can manage their own condition should be the first-line approach to patients concerned about their cold or flu, and the patient should leave the pharmacy safe in the knowledge that their condition should resolve itself in time – generally without an antibiotic.
Sore throats Sore throats can benefit from the soothing effect of a simple linctus, which coats or lubricates the posterior pharynx. Since it is inflammation of this area that typically causes the pain, a soothing effect is generally achieved through this method.
topical anaesthetics such as benzocaine and dyclonine are also used to provide temporary relief of sore throat pain. these are generally available as oral lozenges, but can also be purchased on an otc basis as sprays, gels or solutions.
last year, an interesting walk-in initiative was carried out in England when the ‘Sore throat test and treat Service’ was trialled in 35 Boots pharmacies to determine if a sore throat was of viral or bacterial origin. the service saw pharmacists performing throat swabs to measure the sugar levels on a patient’s tongue. Results were available within five minutes. If a threshold level was reached, the pharmacist was permitted to prescribe antibiotics on
16 - phARmAcY IN focUS
the spot for patients without the need to contact their gp to make an appointment. of the 360 patients, who participated in the scheme, a tenth were provided with a prescription for antibiotics: a major saving on gp time, on inappropriate antibiotic use and, subsequently, on NhS costs.
Respiratory tract infections these are among the most important human health problems due to their high incidence. children are particularly prone to these infections – indeed, it’s estimated that children will experience six to eight episodes per year. the majority of these infections are confined to the upper respiratory tract and present simply as coughs or colds.
Coughs coughs are generally a symptom of most acute respiratory infections (ARI), including both upper respiratory infections, such as coughs and colds, and the more serious lower respiratory infections, such as pneumonia, bronchitis and bronchiolitis.
the distinction between cough due to an upper respiratory infection and cough due to bronchitis is unimportant since both conditions are self-limited viral infections and, as such, don’t require antibiotic treatment. occasionally, the characteristics of a cough can give information about the likely cause of the illness. for example, prolonged coughing followed by a ‘whooping’ sound is found in established pertussis infection, while a barking cough is typical of croup.
the cough reflex functions to clear secretions from the respiratory tract and may therefore actually be beneficial as retention of the secretions may lead to potentially harmful airway obstruction. cough should therefore not be eliminated by drug therapy, but can be relieved by a safe, soothing remedy.
Demulcents are liquids which coat the throat and soothe irritated mucous membranes. consisting primarily of sugar, they act by increasing saliva production and swallowing, thereby interfering with the cough reflex, or by coating the peripheral sensory receptors that trigger the cough. Expectorants are often suitable for patients with a dry cough, who
when patients present with the symptoms of cold, they should always be advised to look primarily to otc products such as cough bottles or nasal sprays
complain that they cannot cough up mucous from their lungs. they act indirectly by stimulating efferent vagal nerve fibres to bronchial glands, resulting in increased volume of bronchial secretions. Expectorants are generally sold in combination with decongestants, antihistamines, bronchodilators and antitussives.
Common cold Almost every episode of the common cold in the developed world is attributable to viruses, including rhinoviruses, parainfluenza viruses, influenza viruses and respiratory syncytial virus.
According to who, drug therapy for viral common colds produces few measurable benefits in adults, and, while symptomatic therapies - particularly oral or intranasal sympathomimetics - may provide short-term clinical relief, all of the treatments for the common cold also have associated side effects.
many patients immediately seek medicines for the relief of their discomfort and also because of their fear that the illness is potentially serious. to date, however, no drug therapy has been shown to cure or shorten the duration of viral upper respiratory tract infections.
According to who, among experimental therapies, alpha-2 interferon has shown some efficacy in preventing experimentally induced rhinovirus infections, but remains experimental due to expense and toxicity.
when patients present with the symptoms of cold, they should always be advised to look primarily to otc products such as cough bottles or nasal sprays. Sufficient fluid intake and adequate rest are also advisable.
put simply, with a little self care, the patient should be able to self manage their condition with little worry or concern.
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