Antidepressants Blog

There are five types of E. coli. Enterotoxogenic E. coli (ETEC) is the most frequent cause. By means of an enterotoxin that stimulates massive fluid secretion, patients present with cramping and explosive watery as well as bloody diarrhea that yields low-level or negative fecal leukocytes on stool testing. Because an overwhelming majority of cases of traveler’s diarrhea are due to ETEC, empiric treatment with a fluoroquinolone without bacteriologic identification of a causative organism is appropriate. Enteropathogenic E. coli is a frequent cause of childhood diarrhea lid causes watery diarrhea that is usually indistinguishable from viral infection. Enteroinvasive E. coli, which is rare in the United States, occasionally causes a dysentery-like syndrome with destruction and severe inflammation of the bowel mucosa and bloody diarrhea. More typically, the diarrhea is watery and self-limited, not requiring treatment. Enterohemorrhagic E. coli usually causes a hemorrhagic colitis without fever or significant inflammation and is associated with hemolytic uremic syndrome (HUS) and thrombocytopenic thrombotic purpura, particularly in pediatric patients. Serotype 0157:H7 is the most well known subtype. The organism is found in undercooked ground beef, and outbreaks have been linked to fast food chains, farms, and petting zoos. It is not identified with routine stool culture media; special cultures can identify the 0157:H7 subtype only. Treatment is not recommended because antibiotics do not appear helpful and may increase the incidence of complications such as HUS.*69/348/5*

The growing interest in alternative medicine—from herbs and homeopathy to meditation and imagery—has been applied with a vengeance to the treatment of colds and flu. Two facts are worth remembering: “natural” does not necessarily mean “safe”—botulinum toxin is 100 percent natural and extremely deadly—and none of the so-called natural remedies have been subject to well-designed clinical studies that could unequivocably establish their effectiveness (or lack of effectiveness). Still, here are some natural remedies that there is good reason to believe may have some usefulness in countering the symptoms of a cold and perhaps speeding recovery. Warning: If you use any herbal remedies, be sure to treat them with the same cautions you would exercise with a “real” drug; overdosing can be just as dangerous since many plants contain potent medicinal substances.

Chicken soup: Popularly known as “Jewish penicillin,” soup made from a fat hen was first prescribed for colds by Moses Maimonides, a rabbi and physician in twelfth-century Egypt. But it doesn’t have to be made by your grandmother to make you feel better. Dr. Marvin Sackner of Mount Sinai Hospital in Miami, Florida, tested soup from a nearby delicatessen and showed that it helped to loosen and clear nasal mucus. See page 57 for my recipe for homemade chicken soup; if my grandmother were still alive, she would insist it is far more therapeutic than anything from a can or store.
Echinacea: This plant, a member of the daisy family, contains substances that are capable of strengthening the immune system and thus may help the body fight off an infection by a cold or flu virus. It should not be used on a regular basis, only when a cold or flu threatens.

Ephedra: This substance, from a broomlike shrub native to China, can be found in some herbal teas, including the American version, Mormon tea. Ephedra is an effective decongestant and it is the prototype for pseudoephedrine, the most popular synthetic decongestant.

Eucalyptus: The aromatic oil from this giant evergreen can help to relieve mucous congestion. It can be used with steam to relieve coughs and it is a component of some cough drops and cough suppressants. Warning: Eucalyptus should not be used for children.

Garlic: Allicin, the active ingredient in garlic, has antiviral properties and may also relieve aching joints (when applied to the skin). Garlic is said to act as an expectorant when consumed in a tea or used in a gargling solution.

Ginger: Ginger tea (made from the fresh ginger root) is a time-honored favorite for getting rid of the chills, relieving sinus and chest congestion, and countering nausea.

Goldenseal: This plant contains an antibiotic substance, berberine, that, like echinacea, is said to stimulate the immune system, prompting it to engulf and destroy infectious organisms. Like echinacea, it should be used only when fighting an illness like a cold or flu.

Imagery: Put yourself in a relaxed, meditative state and use your imagination to picture your strong and powerful immune system attacking those feeble cold and flu viruses. A study conducted by a Harvard University psychologist among thirty healthy students showed that those who used imagery in this way succeeded in boosting their immune systems, especially those elements that would fight off an invading respiratory virus.

Oscillococcinum: Although this homeopathic medicine is more than half a century old, it has yet to be put to a scientific test. Many swear by its ability to ward off colds and flu if taken at the first hint of an impending infection. However, anecdotal evidence does not establish facts. Homeopathy is based on a principle of dilution that in effect produces remedies with little or no active ingredients. The active ingredient in Oscillococcinum is listed as Anal barbariae hepatis et cordis extractum. It is made from many serial dilutions of an extract prepared from the heart and liver of ducks. In all likelihood, it is the user’s belief in its effectiveness that occasionally results in a positive effect.

Peppermint: The aromatic oil of this mint plant is touted as an all-around cold fighter—a decongestant, expectorant, and cough suppressant rolled into one. A strong infusion of peppermint tea, consumed at the first sign of a cold or flu, may or may not keep it at bay but at least can alleviate the symptoms of viral infection, including cough and fever.

Vitamin C: Though well-designed studies have shown no benefit of even large doses of this vitamin in preventing colds, several studies have indicated that when taken at the first hint of an impending cold, it can reduce cold symptoms and shorten the duration of the infection. The recommended doses needed for an effect, though, are very high—about 500 milligrams to 1 gram every hour for the first day, and about half that amount the second day. This may result in gastric and urinary irritation in some people.

Zinc: Evidence for the value of zinc gluconate lozenges in countering the symptoms of a cold is mixed. Some researchers have found it helpful, while others showed no effect. Supposedly, sucking slowly on the lozenge coats the throat with zinc and stops reproduction of cold viruses. One downside: the lozenges may taste awful. Also, beware of overdosing; too much zinc can cause nausea and raise cholesterol levels.
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As if consumers weren’t already confused enough by the hundreds of cold/flu remedies, every year several dozen new products are introduced in hopes that they will capture a significant portion of the more than $1.4 billion over-the-counter market. Most are slightly altered versions of already existing products. Many contain a mix of ingredients, only some of which may be useful while others may be counterproductive.
If any medications are taken at all, experts advise that single-ingredient products be used, chosen to counter the most bothersome of your symptoms. When treating a cold, less is best. The more ingredients you take, the more likely you will experience adverse side effects that may actually make you feel worse. Keep in mind, too, that as a cold progresses, the symptoms change, and so should the treatment.
Pregnant women should not take any medication without checking first with their physicians. The elderly, too, should exercise caution, since they are more likely to experience toxic side effects from both over-the-counter and prescribed drugs. Also, anyone with a chronic health problem, from heart disease to glaucoma, and anyone taking prescribed medication, including psychotherapeutic drugs, should check with a physician before taking any over-the-counter cold/flu product.
Whatever drug you choose, there is no inherent advantage in paying more for heavily advertised “name” brands; generic or storebrand versions will work just as well (or as poorly). Here is what you might find in a cold/flu medicine.
Active ingredients: These are the substances that are supposed to have a direct effect on symptoms. They include analgesics (painkillers) and antipyretics (fever reducers), decongestants, cough suppressants, expectorants, and antihistamines.
Inactive ingredients: These include substances like alcohol that give the medicine form and texture, flavoring and coloring agents, stabilizers, sugar, and caffeine (often added to counter the drowsiness induced by antihistamines, but not too helpful if what you need most is sleep).
Analgesics and antipyretics: The common painkillers—aspirin, acetaminophen, and ibuprofen—play two roles. They relieve headaches and muscle aches and they reduce fever. If a product containing any of these is used, additional pain or fever medication should not be taken. Of the three, acetaminophen is least likely to cause stomach upset. Before taking aspirin or ibuprofen, it is wise to eat something. Aspirin has been shown to increase viral shedding (and thus may help to spread the cold to others) and it may also prolong the infection. Remember, too, that fever is one of the body’s main weapons against infectious organisms, so unless it is very high (say, above 102°F in an adult), you may want to let it run its course.
Decongestants: These help to relieve upper respiratory congestion (stuffy nose and sinuses) by shrinking blood vessels and reducing swelling in the nasal passages. But relief comes at a price. Oral decongestants can cause dry mouth, agitation, insomnia, increased heart rate, and raised blood pressure. Pseudoephedrine is the most popular decongestant used in oral medications. Phenylpropanolamine (PPA), the most common ingredient in diet drugs, is also often used as an oral decongestant, but it is more likely than pseudoephedrine to cause a steep rise in blood pressure. Oral decongestants may interfere with restful sleep and result in daytime fatigue. Limit their use to one week to avoid a rebound reaction— an increase in congestion and dependency on the product. Fewer side effects are associated with topical decongestants in nose drops and nasal sprays. Effective ingredients include xylometazoline, oxymetazoline, ephredrine, and phenylephrine. However, nose drops and sprays should not be used longer than three days; longer use can cause a rebound reaction.
Cough suppressants: These products, also known as antitussives, are used to suppress an irritative, dry cough. Experts recommend that they be reserved for coughs that disrupt sleep. Lingering coughs that interfere with a person’s waking life are best treated with home remedies like ample fluids, cough drops, and lozenges. The most popular cough-suppressant product is dextromethorphan. Others deemed effective are chlophendianol and codeine (a prescription drug that is sleep-inducing and can be habit-forming).
Expectorants: When a cough is “productive”—sputum-producing—it is consider a “good” cough that is cleansing the breathing tubes of excess mucus and potentially infectious microorganisms. The goal is not to suppress such a cough but rather to liquefy and loosen the phlegm so that it is more easily coughed up. This is the role of expectorants. Expectorants may also help to loosen up a “tight-chested” nonproductive cough that results from an accumulation of secretions so thick they cannot be coughed up. The only expectorant approved as safe and effective for over-the-counter use is guaifenesin. Though it may seem counterproductive to take a product that contains both an expectorant and a cough suppressant, the combination may be helpful when taken before bedtime if a productive cough frequently interrupts sleep.

Antihistamines: These products are designed to counter the symptoms of allergies by blocking the effects of histamine. Histamines play almost no role in colds and flu, but antihistamines have a potent drying effect, which has prompted their widespread use in products designed to stop the runny nose that is the hallmark of the early stages of a cold. However, this is one ingredient experts say should be avoided by cold and flu sufferers because it can thicken secretions in the chest and sinuses, making them harder to expel and setting the stage for a secondary infection. The antihistamines approved for over-the-counter use also cause drowsiness, adding to the fatigue induced by a cold and making driving or operating machinery very hazardous. Other side effects may include blurred vision, dry mouth, constipation, and urine retention. The most commonly used antihistamines in over-the-counter products are chlorpheniramine, triprolidine, brompheniramine, and doxylamine.
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