Cold and Flu Medicine: What to Stock for the ‘Tripledemic’ - The New York Times

Doctors weigh in on the essentials families need and what parents can do if they're unable to find children's pain reliever.

The flu and respiratory syncytial virus, or R.S.V., are here with a vengeance, and Covid-19 cases are experiencing a nationwide uptick. Together, these three respiratory illnesses are overwhelming hospitals and disrupting schools and offices.

They're also driving demand for fever- and pain-reducing medications. In recent weeks, some families have struggled to find children's acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Johnson & Johnson — which makes Children's Tylenol and Children's Motrin — said in a statement to The New York Times that there is no nationwide shortage, but increased demand means "products may be less readily available at some stores." The company said it was maximizing production capacity while continuously shipping products out to retailers.

In light of all this, now is a good time to outfit your medicine cabinet so you can be prepared to manage headaches, fevers, coughs and runny or stuffy noses if anyone gets sick. There are only a couple of items that are really essential. And you don't need to stockpile a lot of any one medicine, said Rebekah Wrenn, coordinator for infectious diseases pharmacy services at Duke University Hospital. "You just need to have enough for your family for a potential week of symptoms."

Here is what doctors recommend for soothing flu, Covid and R.S.V. symptoms at home.

The first item that many experts recommend is a digital multi-use stick thermometer, a temporal (or forehead) thermometer or both. A fever can be one of the earliest signs of a viral infection, and being able to objectively measure when your temperature starts rising and how much it spikes can help you figure out how to manage symptoms, as well as how long you may be contagious.

Digital multi-use stick thermometers provide quick, easy-to-read body temperature measurements for people of all ages. They can be used orally for adults and children as young as 4 and under the armpit for anyone (though the American Academy of Pediatrics cautions that armpit temperatures are not always accurate). Multi-use thermometers can also record rectally, which produces the most accurate readings for young children, particularly those under 3 months old.

Temporal thermometers are a good choice for adults and kids because they can measure heat waves coming off the temporal artery in the forehead within seconds, said Dr. Sarah Adams, a pediatrician with Akron Children's Hospital in Ohio. (In-ear and contactless infrared thermometers are other options, but Dr. Adams said they can be more challenging to use accurately.)

It can be useful to have two different types of thermometers at your disposal so you can compare them if a reading seems off, Dr. Adams said. But even if you have just one, using it to take repeated measurements over time, rather than just doing a single reading, can help you ensure the temperatures you're seeing are accurate.

Janice Chung for The New York Times

These come in two categories: acetaminophen (sold under the brand name Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (sold under the brand name Advil or Motrin).

According to Dr. Adams, it's a good idea to have both on hand. "They're two completely different medications" in relation to how they work in the body, she said. Acetaminophen only helps ease pain and fever, while ibuprofen also reduces inflammation.

You can use acetaminophen or ibuprofen interchangeably — it all boils down to personal preference, Dr. Wrenn said. You may choose one over the other to avoid interactions with other medicines you take, or to steer clear of side effects you or your child may have experienced in the past — like stomach pain with ibuprofen. You can also choose based on the formulation: Adult pain- and fever-reducers come in various types of pills; children's medicines come in chewable tablet or liquid form.

You can alternate between acetaminophen and ibuprofen if one doesn't sufficiently bring your fever down and you still have some time before you can take the next dose, Dr. Wrenn said. It's best to avoid high doses or prolonged use of either medication, so pay close attention to the dosing directions and frequency listed for each and don't hesitate to ask a doctor or pharmacist for help, Dr. Wrenn said.

First, take a breath: Doctors stress that there's generally no medical need to bring a fever down unless it's higher than 103 degrees — or is making you or your child miserable. "It's your body's response to infection," said Dr. Michael Chang, a pediatric infectious disease specialist at Memorial Hermann Health System in Houston. That's true for both adults and children, he said, though the children's fever-reducing medicines may be harder to find than adult versions right now.

Pay attention to your child's behavior. If they are generally sleeping, eating and drinking well, experts said it is best to let the fever run its course. The A.A.P. offers guidelines to help parents determine whether a child's fever warrants a call to the pediatrician. However, experts do acknowledge that fever reducers can be helpful for young, nonverbal children because it can be harder to tell when they are feeling uncomfortable and are unable to sleep or eat because of their illness.

If you need to use a fever reducer, you can try a Food and Drug Administration-approved generic version. Generics work the same way as name-brands; choose whichever fever reducer is available that works for your family and situation.

"I just look at the package to see if it is a product that's telling me I have to dose it every two hours, especially if I'm getting it for a child who's really not interested in taking it. Or is it something that has a similar effect and is more long acting?" Dr. Wrenn said.

You can also try non-pharmaceutical interventions. Focus on keeping your child well-hydrated, said Dr. Misbah Keen, a professor and executive vice chair of family medicine with UW Medicine in Seattle, Washington. Place a washcloth rinsed with tepid water on their forehead. Dress them in lightweight clothing and keep the room at a comfortably cool temperature.

Older children may be able to take adult ibuprofen or acetaminophen tablets but you may need to cut them to achieve the correct dosage, Dr. Keen said. The A.A.P. has dosing guidelines based on age and weight. He emphasized it is best to check with your child's pediatrician or family physician first.

If you are experiencing congestion, try a saline spray or drops to help loosen up and remove mucus from your nose, said Dr. Dana Mazo, an infectious diseases specialist and clinical associate professor of medicine at NYU Langone Health. This can also help relieve coughing and sore throat symptoms that are often triggered, at least in part, by accumulated excess mucus draining back into your throat, creating a condition called postnasal drip.

Saline sprays or drops are particularly helpful for children under 4 who may not be able to blow their nose and who should not be given over-the-counter cough and cold medicines because of the risk of side effects, Dr. Adams said. You can also use a saline spray alongside other home remedies that bring relief to irritated noses and throats, such as nasal aspirators, cool mist humidifiers, warm teas or honey. (Honey should not be given to babies younger than 12 months because of the risk of infant botulism.)

Some experts recommend combination cough and congestion relief medicines for adults; others prefer to use separate drugs for each symptom. "It really depends on what symptoms a patient is having," Dr. Wrenn said. "If they have the trifecta of fever, pain, cough and congestion, they may need a combination product. If they just have one symptom at a time, which is usually the way these respiratory illnesses progress, then I would just use one drug at a time."

Combination cough and cold medicines like DayQuil or Theraflu often have a mix of acetaminophen for fever relief, dextromethorphan for cough containment and phenylephrine for nasal decongestion. Some varieties may also include an antihistamine to help open your nasal passages, but they may make you drowsy or the packaging will direct you to take it only at night.

If you do decide to take a combination drug, be sure to read the ingredients and adhere to the dosage directions to avoid unintentionally double dosing with a fever reducer like acetaminophen. Other than that, the brand of the drug doesn't really matter.

"We've all had many colds and respiratory viruses in our lives and have tried different things to treat them," Dr. Mazo said. "If you've found in the past that one brand seems to work better for you or a decongestant works better alone compared to a combination drug, I think taking that is fine."

What experts do agree on is that you should go through your medicine cabinet (or safe storage space) at least twice a year, if not more frequently, and throw out drugs that are expired so you can be confident the medicines you have will work.

"Every season it's a good idea to check what you have on hand," Dr. Adams said.

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