Press release

Surviving the cold and flu season without antibiotics

Public Health England issues advice to help people take care of themselves during the flu season.


Sore throats, runny noses, ear ache, colds and flu-like illness produce a range of symptoms that can usually be managed using over-the-counter medicines and don’t need antibiotics says Public Health England (PHE) and the Royal College of General Practitioners (RCGP). Just because you have green phlegm or snot does not you mean you necessarily need antibiotics.

This advice is issued ahead of Self-Care Week (18 to 24 November 2013) which aims to help people take care of themselves, and lets them know what’s available to help them look after their health. Monday 18 November marks European Antibiotics Awareness Day which aims to raise awareness of the risks associated with the inappropriate use of antibiotics and how to use them responsibly.

People tend to believe that coughs and colds will get better more quickly with antibiotics if they have green phlegm or snot rather than clear phlegm or snot because they see green phlegm as a sign of infection. However, snot and phlegm of any colour is produced by the body as a defence mechanism against dirt, pollen or microbes and as such, is not always a sign of infection. If the body is actually under attack from microbes the immune system is very capable of fighting infections and does not always need medications, including antibiotics, to do it.

The main reasons why patients visit their GP is when their day-to-day activities or sleeping are affected by their illness or if their illness goes on longer than expected.

Here are the typical symptoms of common infections and what can be done to ease them.

Symptom: a sore or irritated throat

  • Pain killers: painkillers help to relieve symptoms of sore throat, fever, and headaches in adults. Use what suits you best and talk to your pharmacist if you’re unsure.
  • Home remedies: you may be able to relieve symptoms of a sore throat by eating cool, soft food and drinking cool or warm drinks, as well as sucking lozenges, ice cubes, ice lollies or hard sweets.
  • Smoking: avoid smoking and smoky environments as much as you can.
  • Fluids: drink at least 6 to 8 glasses of fluid (preferably water) every day, particularly if you also have a fever.

Symptom: coughing with or without phlegm or a hoarse voice

  • Home remedies: you can try simple home remedies, such as ‘honey and lemon’ – just add freshly squeezed juice from one lemon and a teaspoon of honey to a mug of hot water. Drink at least 6 to 9 glasses of water in a day and suck lozenges.
  • Cough mixtures: there is little evidence to say whether over the counter medicines are effective for relieving cough symptoms. Despite the lack of research evidence, you may still get some benefit from over the counter preparations – speak to your pharmacist.
  • Paracetamol: paracetamol can help with relieving symptoms that may accompany a cough, such as a sore throat, fevers, and not feeling well.
  • If you have a dry cough, try not to cough: although this may be easier said than done, you may be able to cough less often by trying not to cough, because our desire to cough can sometimes be influenced by our brain.
  • Stop smoking: smoking is one of the commonest reasons for a chronic cough. Stopping smoking – or at least smoking less –may improve your cough, but also benefits your health in other ways (reducing the risk of heart attack, stroke, and lung cancer, for example).

Symptom: fever in a child

  • Check your child’s temperature: in children aged between four weeks and five years, use either an electronic or chemical dot thermometer in your child’s arm pit, or an infra-red tympanic thermometer in the ear canal. If you haven’t got a thermometer, use your judgement as to whether your child feels abnormally hot.
  • Clothing: avoid over- or under-dressing your feverish child.
  • Heating and cooling: keep your central heating down. Tepid sponging of children is no longer recommended.
  • Fluids: offer your child regular fluids. If you’re a breastfeeding mother, offer your child as many feeds as she/he will take.
  • Medication: you can give either paracetamol OR ibuprofen (not both) if your child is unwell or appears distressed.

Symptom: blocked nose caused by a build up of phlegm or mucus

  • Nasal saline drops: nasal drops may be useful as steam inhalation is not advised

Symptom: sneezing

  • Decongestants: either oral or nasal and these are available from your chemist.
  • Over-the-counter cold remedies: over-the-counter cold remedies will help to reduce sneezing and runny noses.

Symptom: a runny nose with snot of any colour or nasal pain and irritation or blocked sinuses

  • Decongestants: speak to your local pharmacist

Symptom: a general sense of feeling unwell

  • Rest and sleep
  • Pain killers: painkillers help to relieve symptoms of muscle aches,sore throat, fever, and headaches in adults. Use what suits you best and talk to your pharmacist if you’re unsure

Symptom: headache

  • Painkillers: painkillers such as paracetamol, ibuprofen or aspirin.

Dr Cliodna McNulty, head of PHE’s primary care unit said:

There is quite a list of symptoms that people may experience when they have a sore throat, ear ache, cough cold or flu and we understand that people feel pretty awful and want to feel better again as soon as possible. Unfortunately antibiotics will not always help with recovering from these viral illnesses and taking them when you don’t need them feeds into the cycle of antibiotic resistance which means they may not work when you really need them to.

With most respiratory infections it is a case of being patient, managing the symptoms with readily available medications and waiting for the infection to clear naturally from the body which can take three to four weeks.

There are many medications and ways of managing colds and flu so if you have the classic symptoms of a sore throat, cough and are sneezing then speak to your local chemist about ways to make yourself feel more comfortable.

Many people have a good understanding of what antibiotic resistance is but when it comes to their own illnesses still believe that antibiotics can help to treat what can be severe cold and flu symptoms. This is not the case and we must get away from believing this to preserve these precious medicines for when we really need them.

Dr Maureen Baker, Chair of the RCGP, said:

Antibiotics can achieve excellent results if prescribed and used appropriately but patients need to be more aware of their drawbacks - and of the many common conditions that antibiotics will not help.

Many patients have come to expect antibiotics for common colds and infections that will get better naturally or respond better to other treatments, such as over-the-counter medication from pharmacies, closely managing fluid intake and body temperature, and avoiding smoky environments, all of which can be easily managed by the patient.

If antibiotics are used irresponsibly it can lead to longer, more expensive stays in hospital for people with more serious drug-resistant infections. Implementing measures to ensure antibiotics are effectively and only used when it is medically necessary is a clinical priority for the RCGP. We have recently updated the comprehensive TARGET toolkit, developed in collaboration with Public Health England, to include new guidance for GPs and their patients on the appropriate prescription of antibiotics in order to prevent resistance building up in the community.


Notes to Editors

  1. Self Care Week is a campaign is being run by the Self Care Forum in partnership with the Department of Health.
  2. More information about European Antibiotic Awareness Day (EAAD) is available.
  3. The data on public attitudes to antibiotics can be found in the research paper published in the Journal of Primary Care
  4. Materials for GP staff to share with patients may be found on the RCGP website
  5. What are the signs that you should seek medical help for an infection? The following is listed in order of urgency with the most urgent symptoms listed first: * if you develop a severe headache or are sick * if your skin is very cold or has a strange colour, or you develop an unusual rash * if you feel confused or have slurred speech or are very drowsy * if you have difficulty breathing. Signs that suggest breathing problems can include, a) breathing quickly, b) turning blue around the lips and the skin below the mouth, and c) skin between or above the ribs getting sucked or pulled in with every breath * if you develop chest pain * if you have difficulty swallowing or are drooling * if you cough up blood * if hearing problems develop or if there is fluid coming out of your ears
  6. Access the Treat yourself better without antibiotics symptoms checker.
  7. Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter @PHE_uk
  8. The Royal College of General Practitioners is a network of more than 46,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

Infections press office

PHE press office, infections
61 Colindale Avenue

Published 15 November 2013