In a blog for people with minor illnesses and other health concerns amid fears about coronavirus, Sarah Chapman blogs the evidence on over-the-counter medicines and other products. Could we let go of some of the worry about our empty medicine cabinets? Might there be alternatives to our usual purchases?
So our pharmacy shelves are empty of everyday medicines and other healthcare ‘essentials’ that we have taken for granted. For once we can’t even order them online, as I discovered yesterday after making a fruitless search of the house, and then the internet, for a thermometer, while a root through my bags yielded a grand total of six paracetamol. In my head I’m already having an imaginary conversation in which I have to admit I don’t know what my loved one’s temperature is and no I haven’t given them paracetamol but I am doing my best to help them drink plenty of water…
I’ve just reread a blog I wrote a few years ago, with a retrospective sense of “we ain’t seen nothing yet”, about evidence on the The ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. More of over-the-counter (OTC) medicines. “With our A&E departments in crisis,” I wrote, “we’re hearing how we’ve lost sight of how to manage minor illnesses ourselves…”. This seems a good moment to revisit this, to take a look at the evidence on how we can manage ordinary illnesses at home in the extraordinary circumstances of the coronavirus pandemic, and bearing in mind that those of us who have been able to take for granted the availability of over-the-counter medicines and other products can no longer do so. However, if you’re wondering if your symptoms might be coronavirus, please follow the latest advice (see the links in the last section of this blog).
A Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More was published in 2014 on the effectiveness of over-the-counter medicines for A health condition (or episodes of a health condition) that comes on quickly and is short-lived. More cough in adults and children. The review, which includes 29 studies with almost 5000 adults and children, looking at lots of different medicines, highlights that there is no reliable evidence either for or against them. There were few side effects, all minor ones such as headaches, vomiting and drowsiness, but more people would need to be studied to detect serious and less common side effects.
Another Cochrane Review, also from 2014, looked at OTC medicines to reduce cough in children and adults who are on antibiotics for acute pneumonia, and also found an evidence gap, the benefits and harms for people in these circumstances unclear.
Honey for cough in children
Honey has been shown to have properties that work against bacteria, viruses and inflammation and it’s an ingredient in many OTC cough syrups. Many of you will have honey in your cupboards, so could this be useful for soothing a cough? This Cochrane Review (published in 2018) has some evidence that honey may help children with acute cough and Lynda Ware has blogged about the evidence on honey here. It’s important to note that the use of honey for children under a year old is not advised as they could be made ill by the bacteria C. botulinum, which may be found in honey.
Tackling the common cold
There’s been a surge of interest in vitamin C this week, in our coronavirus-dominated conversations, but this 2013 Cochrane Review looking at vitamin C for the common cold (so this can’t be taken to apply to coronavirus) found evidence that it may reduce the likelihood of getting a cold only for people doing short periods of extreme physical activity, such as marathon runners and skiers. More clarity is needed from better studies on the impact of vitamin C on the length and severity of colds.
However, there is reliable, The certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty. Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach More evidence from this 2017 In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More that vitamin D supplementation is safe and helps prevent acute respiratory tract infections, with the most benefit for people who have vitamin D deficiency. There is also high-certainty evidence from this 2015 Cochrane Review that antihistamines can reduce the overall severity of cold symptoms for adults in the first day or two only.
How about the myriad of other things you might hear recommended, such as garlic, steam inhalations, echinacea and decongestants? Lynda Ware has blogged about the Cochrane evidence on a variety of cold remedies here and it is a story of uncertainty – we really need more and better evidence to be confident about the effects, both beneficial and harmful.
A cold will clear up by itself, but meanwhile you can find advice from the NHS on treating a cold yourself, and how to tell the difference between a cold and coronavirus.
Add a dose of caffeine for pain relief?
Many over-the-counter painkillers have caffeine added. As well as wondering if they are worth the higher price, you may well be finding that the shop shelves are now empty of them. I blogged before about this 2014 Cochrane review that has high quality evidence that adding caffeine (100 mg or more) to a standard dose of commonly used painkillers (most often paracetamol or ibuprofen) increases the proportion of people who get good pain relief from common pain conditions like headache and toothache. No serious adverse events were reported and the reviewers say it’s unlikely to be harmful if the recommended dose is not exceeded.
If you can’t get your hands on painkillers combined with caffeine, might drinking a cup of coffee with your usual painkiller be as effective? Review author Sheena Derry thinks it might be, as she commented in response to my previous blog on OTC treatments: “The studies in this review did not state explicitly the form in which caffeine was given to the participants, but coffee is a good source of caffeine and we believe that a mug of strong coffee is equivalent to about 100 mg caffeine. Taking your usual painkiller with a mug of coffee certainly has the potential to be easier and cheaper” – and you might find it works for you.
Water for cleaning wounds
It’s hard to get anything antiseptic in the shops right now, so if you have a cut, is cleaning it with water ok? This Cochrane Review from 2014 highlighted the need for better evidence but, based on the evidence that was available, the review authors found that using drinkable tap water to clean cuts and other new wounds (by showering them) did not appear to make it more likely that they would get infected.
Painful nipples in breastfeeding women
I’ve written more about painful nipples in breastfeeding, but it’s worth repeating that a Cochrane Review (2014) found that applying nothing, or expressed breast milk, may be as good or better than applying an ointment, such as lanolin, for both nipple pain and healing, although better studies are needed to be confident about that. Regardless of the Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. More, for most women, nipple pain reduced to mild levels seven to ten days after giving birth.
So, if you have minor illnesses and health concerns in these strange times…
It’s reassuring to remind ourselves that there are alternatives to our usual purchases, without even leaving the house, and that minor ailments typically get better by themselves, whether or not we do anything.
Need information about coronavirus?
We are being overloaded with information about this, aren’t we? If you’re concerned you might have coronavirus, here’s NHS advice on how to protect yourself or check if you need medical help and here’s stay-at-home guidance from Public Health England for households with possible coronavirus infection.
Help and support
You can look here for a group in your local area, offering help to people during the coronavirus pandemic, and there are many community initiatives popping up all over the place, advertised on social media, leaflets through doors and so on.
Stay well, stay connected, and stay away from misinformation!
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Sarah Chapman has nothing to disclose.