Popular 'flu packs' illegal, can have long term health effects

Popular "flu packs" sold over the counter at pharmacies in Bulawayo have come under increasing scrutiny amid concerns over their legality and the potential health risks associated with their use, particularly the growing threat of antimicrobial resistance.

The concern comes as seasonal respiratory illnesses become more common during the cold months, prompting many people to seek quick and affordable relief from symptoms such as coughing, sneezing, sore throats, headaches, fever and body aches.

Often sold for as little as US$1, the flu packs have become a popular option in many pharmacies. The packs, which gained prominence during the Covid-19 pandemic when similar combinations were marketed as "Covid packs," typically contain a mixture of medicines packaged together and sold as a single treatment for flu-like symptoms.

However, medical professionals and regulators have raised alarm over the inclusion of prescription medicines, particularly antibiotics, in some of the packs.

Local physician Misheck Ruwende warned that the widespread use of antibiotics for viral infections is medically inappropriate and could worsen the growing problem of antimicrobial resistance.

"I have no idea of what that is. I am hearing it from you. As long as there is an antibiotic, there is nothing that we are doing. Flu is a virus, it doesn't need antibiotics," said Dr Ruwende.

"It is only making things worse in Zimbabwe because we are already dealing with resistance, which is why at times you are prescribed antibiotics and it doesn't work."

He said most common flu infections are caused by viruses and generally require supportive treatment rather than antibiotics.

"I do not see the sense of a flu pack anyway because flu must be treated with paracetamol, Vitamin C to boost your immune system and water. It is just a virus," he added.

Investigations indicate that some flu packs sold in the city contain a combination of medicines including antibiotics such as Amoxicillin and Azithromycin, corticosteroids such as Prednisolone, antihistamines including Chlorpheniramine and Allergex, as well as Vitamin C and Paracetamol.

In some cases, patients are reportedly instructed to take up to eight tablets at once despite obtaining the packs without a doctor's prescription.

The Medicines Control Authority of Zimbabwe has warned that selling antibiotics without a valid prescription is illegal and poses a serious public health risk.

MCAZ spokesperson Davison Kaiyo said the practice contributes directly to antimicrobial resistance.

"The sale of antibiotics without a prescription is illegal. This gives rise to the challenges of antimicrobial resistance. Antibiotics must only be sold upon presentation of a prescription," said Kaiyo.

According to the World Health Organization, antimicrobial resistance occurs when bacteria, viruses, fungi and parasites evolve and no longer respond effectively to medicines, making infections harder and more expensive to treat and increasing the risk of severe illness and death.

Health experts have also expressed concern over the lack of standardisation in the composition of flu packs.

Different pharmacies reportedly prepare different combinations and dosages of medicines, raising the possibility of patients receiving unnecessary medications, inappropriate dosages or potentially harmful drug combinations.

Particular concern has been raised over the inclusion of corticosteroids such as Prednisolone, which can suppress the immune system and should generally be used under medical supervision.

Some pharmacists defended the practice, arguing that they rely on their professional training when preparing the packs.

"While we understand that selling these flu-packs is illegal, what you should understand is that we are pharmacists by training and we work with these medicines on a daily basis," said one pharmacist who requested anonymity.

"When we prescribe something, it would be after proving that indeed it works."

The pharmacist added that practitioners would not intentionally expose patients to harm and argued that the continued demand for the packs reflected their perceived effectiveness.

However, another pharmacist said some pharmacies have already stopped selling the packs after being advised by authorities that the practice contravenes regulations.

"What they realised was that these flu-packs particularly affected patients with high blood pressure, diabetes and other medical conditions," the pharmacist said.

"The dosages of these packs are usually high and can be very risky, hence the decision to ban them."

Health authorities continue to urge members of the public to seek professional medical advice when experiencing symptoms of illness and to obtain prescription medicines only through authorised and lawful channels.

Experts warn that unless the misuse of antibiotics is addressed, Zimbabwe could face a growing burden of antimicrobial resistance, reducing the effectiveness of treatments for common infections and placing additional pressure on the healthcare system.