Australian doctors report that flucloxacillin, a semisynthetic penicillin, can cause cholestatic jaundice (Med J Aust, 1989; 151: 701-5), though its relation to the drug may go unrecognised because of a delayed onset (Lancet, 1992; 339: 679). Older patients and those receiving flucloxacillin for more than two weeks are particularly at risk (BMJ, 1993; 306: 233-5).
Newer combination antibiotics such as Septrin - trimethoprim and sulphamethoxazole, or co-trimoxazole - have been linked with skin rashes and blisters (Ind J Derm, 1982; 48: 207-8; Br J Dermatol, 1987; 116: 241-2; Dermatology, 1986; 172: 230-1), and a host of HIV-like symptoms, including anaemia, loss of appetite, nausea, vomiting, numbness, convulsions, chills, fever, swollen glands, and ulcers in the mouth, eyes and urethra.
Overuse of antibiotics also contributes to the emergence of ‘superbugs’, and can deplete the friendly gut bacteria needed to maintain good health and immunity. Clearly, when you take antibiotics, you are risking a trade-off of symptoms which may leave you more unhealthy than you were before.
Over-the-counter madness
If you do succumb to a cold or flu, there are literally hundreds of over-the-counter (OTC) remedies that claim to relieve cold symptoms, but most have been proven useless (J Am Med Assoc, 1993; 269: 2258-63). The most popular varieties use a scattergun approach, mixing several different types of ingredients, often resulting in a variety of side-effects.
For instance:
*Nasal sprays containing phenylephrine hydrochloride, oxymetazoline hydrochloride or xylometazoline hydrochloride may clear the nose initially but, after a few days, their continued use can cause a rebound effect, producing worse nasal congestion than before.
* Oral decongestants stimulate the sympathetic nervous system and can increase blood pressure and pulse - risky for those with hypertension. They can cause heart rhythm disturbances, anxiety and a rebound effect. Perhaps the worst offender is phenylpropanolamine (PPA). In one study, this chemical increased the risk of stroke in women more than threefold (N Engl J Med, 2000; 343: 1826-32). This was the last straw in more than a decade of studies of PPA. The US Food and Drug Administration (FDA) has asked drug companies to stop marketing products containing PPA but, in the UK, it is still widely found in cold remedies.
* Antihistamines may reduce a runny nose and sneezing, but have a minimal effect on other symptoms. They can have a sedating effect and are often added to multisymptom cold remedies because of their ability to counteract the stimulant effect of decongestants.
* Cough suppressants such as guaifenesin (Robitussin) and dextromethorphan (NyQuil or Night Nurse) show no efficacy in suppressing coughs. The latter has been associated with liver damage and is used by teenagers to get a 'poor man’s high'. Codeine also doesn’t suppress coughs, but can result in constipation.
* Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, paracetamol (acetaminophen) and ibuprofen may in fact increase nasal symptoms. There is also evidence that aspirin decreases the antibody response in rhinovirus infections (J Am Med Assoc, 1975; 231: 1248-51; J Infect Dis, 1990; 162: 1277-82). Furthermore, the influenza virus grows best at 34-35º C, but poorly - if at all - at temperatures greater than 37º C. So reducing fever with NSAIDs may simply prolong the agony of a cold or flu.
To jab or not to jab?
Predicting a flu epidemic is not an exact science, as was elegantly illustrated in 1976 when US officials, spurred on by illness among soldiers at Fort Dix, New Jersey, predicted a swine flu epidemic as lethal as the great flu pandemic of 1918. In the event, rates of flu and pneumonia-related deaths in 1976 were at their lowest in years (MMWR, 1976; 25: 391-2), much to the chagrin of the government, which had spent millions preparing a vaccine.