Working the Bugs Out

“This Season, Don’t Take the Flu Lying Down,” boasts the advertisement for one of two new prescription anti-influenza medications. It’s just one of a slew of television and magazine spots aimed at those who may have played hooky on flu-shot day.

Research does show that anti-flu medications, including two old-timers and two drugs just approved by the U.S. Food and Drug Administration this year, can help ease symptoms and can actually shorten the duration of the flu by a couple of days. Multiply those days by the 70 million people Americans who, according to the U.S. Centers for Disease Control and Prevention, will get the flu this year, and you’re talking a lot less misery.

But these drugs won’t stop a cold. So it pays to know if you really have the flu before you shell out $40 to $50 for the drugs, which generally aren’t covered by insurance because they just alleviate symptoms and don’t provide a cure. While a cold often comes on slowly and may start with a runny nose, the flu usually whacks you over the head with sudden fever, chills, muscle aches, a dry cough and perhaps a sore throat.

Shortening the length of the illness and making it less nasty are reasons enough to take the anti-flu medications, says Dr. Jeffrey Galpin, an associate professor of clinical medicine at USC.

“There are lots of reasons to abort influenza,” even if the drugs don’t offer a complete cure, Galpin notes. “Influenza can lead to acquired asthma in adults. And it causes lots of secondary bacterial infections.” As many as 75% of patients who develop bacterial pneumonia started off with the flu, he adds.

Here’s a rundown on the available anti-flu medications:

* Relenza (generic name--zanamivir): Approved by the FDA in July, it’s the first in a new class of drugs called neuraminidase inhibitors. These drugs interfere with the release of the influenza virus on the surface of the lungs, interrupting the spread of the infection in the respiratory tract. The medication, in powder form, is inhaled through the mouth.

Side effects can include a mild cough or bronchospasm in people with asthma.

Relenza is the first drug approved in the U.S. for treating both influenza A and B in adults. (Type A is the most prevalent strain and is associated with the most serious epidemics, according to the National Institutes of Health. Type B outbreaks also can reach epidemic levels, but the disease produced by type B is usually milder. Type B usually accounts for less than 10% of all cases of influenza, according to Dr. David Pegues, an epidemiologist at UCLA Medical Center.)

* Tamiflu (generic name--oseltamivir): Received FDA approval in October. Another neuraminidase inhibitor, but in pill form, intended for treatment of influenza A or B in adults.

Side effects include stomach upset, and it is recommended that the medication be taken with food, notes Pegues.

* Flumadine (generic name--rimantadine) and Symmetrel (generic name--amantadine). Both flu drugs have been on the market since the early ‘90s. Originally approved as a treatment for Parkinson’s disease. These drugs help prevent the virus from penetrating the cells of the lungs. Rimantadine is a derivative of amantadine, and both are effective against influenza A only. Both may cause lightheadedness, inability to sleep and gastrointestinal side effects in some people, according to the CDC. Side effects are more common with amantadine but usually aren’t severe.

All anti-flu drugs are effective only if taken soon after symptoms appear. “It’s important to start taking the medication within two days of onset of symptoms,” Pegues notes. Also, none of these drugs should be taken if you’re pregnant.

Antibiotics, which treat bacterial infections, aren’t effective against the flu. But if flu symptoms lead to a bacterial infection, then antibiotics may be prescribed, says Pegues.

Even though the anti-flu drugs are helpful, they’re still no substitute for rolling up your sleeve and getting that flu shot--even this late in the year, says Pegues, noting that the flu season peaks in January and February and continues into March. While it is recommended that people get flu shots in the fall, you can still get protection by getting the shot between now and the end of January, he says.

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Other doctors, however, see some possible downside to getting the flu shot in December. USC’s Galpin said he has stopped recommending flu vaccinations for his patients for the rest of the winter.

“After you get the flu shot, your immunity is lowered for about a week,” he says. If you happen to catch the flu during that week, you could be stuck with a worse case than you might otherwise have.”

So if you’re considering getting the flu shot any time soon, you’ll want to discuss the pros and cons with your doctor.

Dr. Vanessa Tatum, an Inglewood internist and pulmonary specialist, recommends that high-risk patients go ahead and get the flu shot, even now. But she recommends that those patients take Flumadine for two weeks to cover them until the immunization becomes effective.

Skipping the flu shot simply because the anti-flu drugs are available is unwise, says Pegues, who also advises against using anti-flu medications as a preventive measure during the months-long flu season. (Although research has shown that these drugs do have some preventive benefits.)

“It’s expensive, the drugs are not approved for that use, and it isn’t any more effective than getting the vaccine,” Pegues says. An exception might be for a patient whose immune system is suppressed and for whom getting the flu could be life-threatening, he notes. To play it safe, Galpin recommends that high-risk patients take a half dose of Flumadine for the duration of the flu season.

Doctors say they can generally diagnose the flu by looking at symptoms. But if you and your doctor want to make sure you actually have the flu, there’s a new test, ZstatFlu, for diagnosing influenza A and B. The ZstatFlu test is performed in the doctor’s office with a throat swab. Test results are available within 30 minutes.

Galpin, however, is skeptical about the test.

“It’s just coming out, and it will be two to three years before we know if it’s useful,” he says.

Vaccination rates would probably be much higher if people didn’t have to face the needle. And one medical company is developing a product that would be good news for those who fear the needle.

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FluMist, an influenza vaccine being developed by Aviron and Wyeth-Lederle Vaccines, is sprayed as a fine mist into the nostrils and provides immunity in the nose. It’s made from weakened, live viruses rather than from dead viruses, which make up the conventional vaccine. FluMist looked promising in recent clinical trials that included more than 4,500 people, according to a recent study published in the Journal of the American Medical Assn.

The companies hope to gain FDA approval for FluMist and begin marketing the product by winter of 2001.

Of course, if this year’s flu virus sneaks up on you, you probably won’t be thinking much about 2001. You’ll be concentrating on the tasks at hand: dragging yourself to the couch, finding the TV remote and wondering why every talk show makes your head hurt.

But if the flu’s aches, pain and fever do hit you this winter, it’s good to know your doctor can prescribe more than just chicken soup.