I’m sure you have heard it in the news or know someone who is ill but everyone seems to be sick right now. My practice has certainly been very busy with cold and flu symptoms.

What is the difference between a cold and the flu?

The flu and the common cold are both respiratory illnesses but are caused by different viruses, They can have similar symptoms but generally flu symptoms are more severe. Cold symptoms usually include head congestion, runny nose, sneezing and a cough. Flu symptoms generally include dry cough, body aches, fevers, extreme fatigue and sometimes nausea, vomiting and diarrhea. Colds usually do not progress into serious health conditions, but the flu may develop into pneumonia or other conditions that may require hospitalization.


Colds generally will last less than a week. If your symptoms persist longer than a week and you’re not starting to feel better, than you should go see your doctor for further evaluation. If your symptoms worsen or you start to develop fevers, shortness of breath, and productive cough, then you should also see your doctor.

Colds and flu are caused by viruses, not bacteria, thus they will not respond to antibiotics, so don’t go running to the urgent care for a Zpack.  In severe cases of the flu, a secondary bacterial pneumonia may develop that would require the use of antibiotics.

What about the flu shot ?

The flu shot is not 100% effective in preventing the flu. Its effectiveness varies every year, but generally it is only about 60% effective. There are reports that this year’s flu vaccine is only about 30% effective. Every year a panel of experts decide on which flu strains may become predominant and formulate the vaccine. The experts make a scientific prediction on which flu strains will need to be vaccinated against. They of course don’t always get it right and sometimes the flu virus can mutate and change, rendering the vaccine ineffective.


Antiviral medications such as, Tamiflu, Relenza and Rapivab, are indicated for treatment of the flu. These medications need to be taken within the first 48 hours of developing the flu to be effective. If they are effective, they have only been shown to decrease the duration of the flu by 1-2 days. They typically cost @ $100 for treatment and are generally not covered by insurance. They are not without possible side effects; severe skin rashes, blistering, changes in behavior and more commonly nausea and vomiting.

Antivirals are indicated for people who are sick enough to be hospitalized with the flu, those with severe health problems such as asthma, pulmonary disease or heart disease, adults age 65 or older, morbidly obese and residents of nursing homes.

The flu vaccine is meant to prevent you from getting the flu, while antiviral medications mentioned above, treat you if you already have the flu.

Mucus color and antibiotics

This subject regarding the color of one’s mucus or phlegm determining the need for antibiotics is another one of the most frustrating medical myths primary care physicians encounter in their practices. Since we are now into cold and flu season, I deal with this type of question quite frequently in my own practice.

When you have cold symptoms and blow your nose or cough up phlegm that is green, this does not mean you have a bacterial infection which would need antibiotics. The green color comes from enzymes released by your white blood cells used to fight off the infection. When your sinuses are clogged during a cold, the mucus in the sinuses will stagnate and appear green when you sneeze or blow your nose.

The bottom line is that green mucus or phlegm does not mean you need antibiotics.

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