Flu Packs Under Scrutiny as Health Experts Warn of Antibiotic Misuse in Zimbabwe

BULAWAYO – Popular over-the-counter "flu packs" sold by some pharmacies in Bulawayo are facing growing scrutiny amid concerns over their legality, safety, and potential contribution to antimicrobial resistance, a public health threat that experts say is already affecting treatment outcomes in Zimbabwe.

The concerns come as seasonal respiratory illnesses become more prevalent during the winter months, driving demand for quick and affordable remedies for symptoms such as coughing, sneezing, sore throats, headaches, fever, and body aches. Often sold for as little as US$1, flu packs have become a common feature in some pharmacies. The packs, which gained popularity during the Covid-19 pandemic when similar combinations were marketed as "Covid packs," typically contain multiple medications packaged together and sold as a single treatment for flu-like symptoms. However, health professionals and regulators have raised alarm over the inclusion of prescription medicines, particularly antibiotics, in some of these packages.

Bulawayo physician Dr Misheck Ruwende warned that the routine use of antibiotics to treat viral infections is medically inappropriate and could worsen the growing problem of antimicrobial resistance.

"I have no idea 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 explained that the 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 combinations of medicines that may include 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 reportedly receive instructions to take several tablets simultaneously despite obtaining the packs without a doctor's prescription.

Medical experts warn that such practices may expose patients to unnecessary medication, incorrect dosages, and potentially dangerous drug interactions. Particular concern has been raised over the inclusion of corticosteroids, which can suppress the immune system and should generally be administered under medical supervision.

The Medicines Control Authority of Zimbabwe (MCAZ) has warned that dispensing antibiotics without a valid prescription is unlawful and poses significant risks to public health. 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 (WHO), antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve and no longer respond effectively to medicines, making infections more difficult and costly to treat while increasing the risk of severe illness and death.

Health experts have also expressed concern over the apparent lack of consistency in the composition of flu packs. Different pharmacies reportedly prepare varying combinations and dosages of medicines, creating uncertainty about what patients are consuming and whether the treatments are appropriate for their conditions. The absence of standardisation may increase the risk of adverse drug reactions, especially among people with chronic illnesses such as diabetes, hypertension, and heart disease.

Some pharmacists defended the use of flu packs, arguing that their professional training enables them to determine suitable medication combinations.

"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 healthcare professionals would not intentionally expose patients to harm and argued that continued public demand demonstrated confidence in the products.

However, another pharmacist said some pharmacies had already discontinued the practice after being advised by authorities that it contravenes pharmaceutical 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 encourage Zimbabweans experiencing flu-like symptoms to seek professional medical advice and obtain prescription medicines only through lawful and authorised channels. Experts warn that unless inappropriate antibiotic use is curtailed, Zimbabwe could face an increasing burden of antimicrobial resistance, reducing the effectiveness of treatments for common infections and placing additional strain on the country's healthcare system.

As winter illnesses rise, regulators and healthcare professionals say public awareness, responsible prescribing practices, and stronger enforcement of pharmaceutical regulations will be critical in protecting both individual patients and broader public health.

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