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The flu bug has left most of us alone so far this winter, although stomach viruses have kept spider webs from forming on the drugstore shelves. Even colds and other respiratory bugs have been relatively rare.

It's still early, though.

"We didn't really have a peak last year until March," said Greg Rozelle, director of personal health for the Combined Health District of Montgomery County. "The season starts in December, but you can still get flu sometimes as late as May. There's still time to get a flu shot."

Colds and their byproducts — ear, throat and sinus infections — are even a surer bet to strike sometime before spring. Colds are the leading reason for doctor visits and school or work absences in the United States. They're not curable, while antivirals can diminish flu in certain circumstances.

"For either one, you're treating the symptoms," Rozelle said. Coughing and sneezing, aches and pains, fever and fatigue can range from annoying to debilitating, but many of the drugs for combating them range from useless to dangerous.

No over-the-counter cough medicines are effective, the American College of Chest Physicians determined last year, and the only useful nonprescription decongestants require a signature. Antibiotics often do more harm than good. The government has issued warnings about painkillers, Tamiflu and all cold and cough medicines for by children younger than 2.

Here, then, is a guide to relieving cold and flu symptoms, where the solution may lie outside the medicine cabinet.

Contact this reporter at (937) 225-2129 or klamb@DaytonDailyNews.com.

Antibiotics

They cure only bacterial infections, but also can prevent the sinus or ear infections that might follow a cold or flu. Prescriptions are steadily decreasing, especially among children, because the country's high use of antibiotics is helping to breed bacteria that are resistant to routine antibiotics.

A study of Atlanta clinics, for example, found nearly 75 percent of serious skin infections were resistant. Some suggest that antibiotics contribute to obesity by disrupting beneficial digestive bacteria.

Our immune systems will fight off most infections without medication. We could do a lot more to help them just by getting enough rest, handling stress and eating healthy food. Fruits and vegetables, especially, can help stave off infections with their antioxidants.

Sugars can interfere with immune function and often are plentiful in unexpected foods. Check labels for corn syrup or anything ending in "ose," and especially avoid soft drinks, fruit juices and sports drinks.

Finish the bottle whenever you're on an antibiotic, even after all symptoms are gone. Otherwise, some bacteria will remain behind to adapt and survive the next course of antibiotics. That's how they become resistant. Avoid antibacterial soaps, tissues and cleaning products for the same reason.

Also, when taking an antibiotic, it's wise to take L. acidophilus supplements or other probiotics. They head off infections of the skin, vagina, and digestive and urinary tracts by keeping antibiotics from killing too many beneficial bacteria.

Ear infections can make life miserable for a sick child's whole family, so parents often beg for antibiotics. But the problem isn't bacteria, it's pain, which small doses of acetaminophen or ibuprofen usually relieve. Four of five ear infections clear up on their own in about three days, so researchers recommend antibiotics only if the infection persists and is bacterial.

When patients ask for antibiotics, they usually mean pain relief, the Annals of Family Medicine reported last month, so doctors should focus their efforts there.

Congestion

Drinking water is the best decongestant. By diluting mucus, fluid intake makes expelling it easier, so experts recommend at least 64 ounces a day. Lemon can add taste, and decaffeinated drinks such as green tea also help.

But avoid milk products, which can thicken mucus; caffeine, which drains the body of fluids; and alcohol, which can swell the sinus membranes.

Chicken soup has substances that researchers have found makes mucus easier to expel from the lungs and may even assist the immune system. Pepper and other spices, whether in the soup or not, also thin respiratory mucus.

Nonprescription decongestant drugs are only effective if they have pseudoephedrine, and those can be purchased only with identification and a signature. They can cause high blood pressure, anxiety, urinary difficulties, dizziness and drowsiness even in healthy people. So they're to be avoided by people with those conditions or with heart disease, glaucoma, diabetes or hyperthyroidism.

Decongestant nasal sprays, such as Afrin or Neo-Synephrine are safer, so the January Consumer Reports recommends trying them first — but never for more than three days, or they can make congestion worse.

Salt-water nasal sprays, such as Ocean, contain no medicine but can relieve mild congestion and loosen mucus.

Steam also loosens congestion effectively, either from a humidifier or a pot on the stove. Drape a towel over your head and inhale from steaming hot water three or four times a day, Consumer Reports suggests.

Coughing

Nonprescription cough medicines don't help, the American College of Chest Physicians concluded. They said medicines with dextromethorphan safely suppress the neurological cough reflexes, but only at prescription doses.

Older antihistamines, such as Benadryl or Chlor-Trimeton, were the chest doctors' nonprescription recommendation. They've been largely replaced by newer ones that don't cause drowsiness, but getting a good night's sleep is one of the main motivations for wanting to suppress a cough. That's why whisky is a longtime remedy.

Relieving congestion can relieve coughs, since postnasal drip irritates the throat.

See a doctor if a cough lasts three weeks or brings up blood or phlegm that's thick and discolored. Coughs can signal more serious pneumonia, bronchitis, asthma, even heartburn.

Pain and fever

The same nonprescription medicines attack them both, but, unlike pain, relieving fever isn't always a good idea. Fever is a sign the body is fighting infection, and is generally harmless below 102 degrees. Research has found aspirin and Tylenol impede the immune system, which can lengthen an illness.

Acetaminophen is associated with more than half of the country's acute liver failures, and it often happens quickly. The active ingredient in Tylenol, it also is in more than 100 other nonprescription products, so read the ingredients and don't take more than 4,000 milligrams a day — the equivalent of eight extra-strength Tylenols.

Also, never take it longer than five days, or with alcohol, said Dr. Guy Neff, a liver transplant surgeon with the University of Cincinnati. The first signs of liver damage are yellowing eyes or abdominal pain or bloating.

The risk with aspirin, ibuprofen (Advil) and naproxen (Aleve) is gastro-intestinal bleeding and kidney injury, even at recommended doses, so watch for digestive symptoms.

Children should never take aspirin with fevers, which rarely can be fatal or disabling.

Throat pain can be relieved by gargling with salt water and sleeping with a humidifier, since dehydration irritates the throat. Warm drinks, soups and syrupy liquids also help, and glycerin or honey coat the throat.

Lozenges can be helpful by temporarily numbing the throat or at least lubricating it. "Medicated" ones don't add anything, last month's Consumer Reports on Health said.

Slippery elm gives the best-regarded herbal relief for sore throats, but ask if it interferes with medications, and buy it only from a reputable manufacturer.

Ear and sinus pain respond temporarily to warm compresses. For sinuses, the Duke Encyclopedia of New Medicine suggests alternating hot and cold compresses, which also relieve congestion: three cycles of hot for 3 minutes, then cold for 30 seconds.

Antivirals can make flu less severe if taken within 48 hours of symptoms, but the most popular one, Tamiflu, has been linked to rare cases of delirium in children. Tamiflu also loses potency if taken with Plavix, an anti-clotting heart drug.

Heartburn drugs that suppress gastric acid increase the risk of pneumonia, the Journal of the American Medical Association reported Oct. 27, 2004, apparently by giving germs a more favorable environment.

Children and

nonprescription drugs

More than 1,500 children younger than 2 had to go to emergency rooms in 2004 and '05 because of reactions to nonprescription cold and cough medicines. The American College of Chest Physicians recommends against giving them to anyone younger than 15.

Instead, Dr. Michael Marcus of Children's Hospital in New York suggests fluids, lots of kisses and time. "Infections are viral and will pass in a few days."

Doctors also recommend suction devices, similar to turkey basters, for removing children's nasal secretions.

Colds versus the flu

The worse it feels, the more likely it's the flu and not a cold. "You can tell from the sudden onset and real malaise, where people can't even get out of bed," said Greg Rozelle of Montgomery County's Combined Health District.

Sudden onset and high fever are the flu's most distinctive features. The flu causes aches all over the body, while colds are localized to the respiratory tract. Coughing, sneezing and congestion are more characteristic of colds than of flu.

The question isn't just personal-health trivia. The flu causes severe illness for a week and weakens people for several weeks, so it's much more likely to spin out of control into life-threatening complications.

People with the flu need to protect their bodies with rest and fluids and act on worsening symptoms, especially if they're older than 65, smokers or at risk for complications. Shortness of breath, a persistent cough and fever with chills are signs to see a doctor.

Hospitalizations for pneumonia increased by 20 percent over 12 years, the Journal of the American Medical Association reported last winter. Pneumonia taxes the immune system so much that it makes people vulnerable to other problems. Even the flu and bronchitis have been associated with heart attacks, the University of Cincinnati's Dr. Neal Weintraub said.

Cold does cause colds

Getting chilled really does increase the risk of catching a cold, Welsh researchers reported in 2005. When half of 180 volunteers put their feet in cold water for 20 minutes, 29 percent of them caught colds, compared to 9 percent of the others.

The results didn't surprise some specialists who have long recognized that stress impairs immune function, and that cold is a stressor. Other researchers have found chilling narrows blood vessels in the nose, restricting its supply of infection-fighting blood cells.

Check the date

Nearly two-thirds of adults in a Medicine Shoppe Pharmacies survey admitted they take expired medicines, probably because 80 percent in the survey said they don't buy cold and flu medication until they're sick.

Stocking up in advance "is critically important," specialized care director Bill Bailey said. "Taking medications that already have expired not only limits your chances of recovering quicker, it can, at times, prove to be harmful."

People also should reconsider where they store their medicines. Humidity and large temperature changes can break down drugs, but 49 percent store them in bathrooms and 29 percent in kitchens.

The rules

Wash hands frequently, especially after touching a nose or mouth.

Sleep and healthy food fortify the immune system, so get enough of both.

Stress impairs the immune system, so do what it takes to relieve it.

Avoid tobacco smoke, especially your own.