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Online Pharmacies Seen Fueling Antibiotic Overuse

Pills in blister packs

(Public Domain Pictures, Pixabay)

17 February 2017. A study of pharmacies selling drugs online shows many of these sites offer antibiotics to consumers in the U.K. without prescriptions, which would be illegal in retail drug stores. Researchers from Imperial College London published their findings in today’s issue of the Journal of Antimicrobial Chemotherapy.

Resistance to antibiotic drugs is a growing public health problem that results from microbes evolving to evade treatments from currently prescribed antibiotics. That evolution can occur naturally, but the routine use and over-reliance on antibiotics is speeding the process, with grave consequences for people suffering from infectious diseases. World Health Organization says diseases such as pneumonia, tuberculosis, and gonorrhea are now more difficult to treat as current antibiotics become less effective.

A team from the lab of senior author Alison Holmes, professor of infectious diseases at Imperial, examined the role of online-only pharmacies in the U.K. that provide antibiotics on demand. In the U.K., pharmacies are required by law to sell antibiotics to consumers only with a valid prescription. The availability of antibiotics in the U.K. from online-only vendors, however, is an open question, as well as any safeguards or guidance for patients they provide.

Project leader Sara Boyd, a clinical fellow in infectious diseases and microbiology at Imperial, and colleagues searched Google and Yahoo with the term “buy antibiotics online.” The team then collected distinct URLs for online pharmacies from the first 10 entries on the first returned page, which reflects common Internet search engine practice. From these searches, the researchers explored antibiotic sales practices of 20 online pharmacies serving consumers in the U.K., to the point of paying for their purchases.

Of the 20 pharmacies in the sample, 5 sites were physically located in the U.K., and registered with national authorities. Of the remaining 15 pharmacies, the locations of 10 sites were unclear, with the others located in India (3) or Cyprus (2). All pharmacies offered oral antibiotics, with one site selling antibiotics in intravenous form.

The results show many of the online pharmacies sampled ignore laws requiring prescriptions for antibiotics, with some sites providing little, if any guidance on their use or safety to consumers. Nearly half — 9 of 20 online pharmacies — provide antibiotics without a prescription. All 5 of the U.K.-based and registered sites are among those requiring a prescription. The 11 sites requiring a prescription allow for one or more of online, mail, or fax deliveries of the document.

The team rated the online pharmacies as either consumer- or prescriber-driven in their interactions with visitors. A consumer-driven site lets visitors choose the antibiotic, as well as the dosage and quantity. Prescriber-driven sites first require an online consultation describing the ailment that result in recommendations for purchase. Researchers found only 4 of the sites are prescriber-driven, while 16 sites or 80 percent of the pharmacies are consumer driven. All 4 of the prescriber-driven sites are located and registered in the U.K.

Many of the online pharmacies exhibit little concern for patient safety, say the authors. Some 14 out of 20 pharmacies, or 70%, offer no health questionnaire when buying antibiotics. In addition, 6 of the pharmacies provide no information before purchase on side effects or situations where the drugs should be avoided.

The researchers conclude these online sales practices can contribute to the growing problem of antibiotic resistance. “Improper use of antibiotics,” says Holmes in a university statement, “can mean that infections are not being treated appropriately, or that people are being unnecessarily exposed to antibiotics. This allows bacteria to become resistant to the drugs that once killed them. As a result, it is essential that antibiotics are prescribed only when they are needed.”

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