Availability of Antibiotics for Purchase Without a Prescription on the Internet

Abstract

PURPOSE Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient selfmedication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODSWe conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTSWe found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fl uoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer.CONCLUSIONS Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care. INTRODUCTIONA ntibiotics serve a useful therapeutic purpose in treating and controlling the impact of pathogens. Antibiotic resistance is a global problem, however, and has been described with numerous pathogens and in varying contexts.1 Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US public health and national security by the Institute of Medicine and the Infectious Diseases Society of America. 2,3Although excessive use of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of therapeutic antibiotics focus almost exclusively on controlling prescribing by health care clinicians.1,4,7-10 As a result, most estimates of the reservoir of antibiotics in the community are based on evaluations of clinician-prescribing behavior.Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the [16][17][18][19] Patients are increasingly using the Internet not only to access health information but also to obtai...

Antibiotic Abuse in Developing Countries

“…Furthermore, from subjects that experienced self medication with antibiotics including amoxicillin, ampicillin, fradiomicyn-gramicidin, ciprofloxacin and tetracycline, those antibiotics were used to treat minor diseases such as common cold, cough and fever [14]. A recent study from Mainous et al [16] have highlighted that currently antibiotics are freely available for purchase on the Internet without a prescription, thus encouraging selfmedication and low quality of care.…”

In This Issue: Critical Topics in Primary Care

“…Mainous et al fi nd that antibiotics are widely available on the Internet without prescription. 7 Given the unregulated nature of the Internet, these fi ndings may have serious implications for patient health, quality of care, and efforts to reduce antibiotic resistance.…”

In This Issue: Multifaceted Research

“…I n follow-up to a study showing the wide availability of antibiotics without prescription via the World Wide Web, 1 Mainous and colleagues found that a year-long multimedia campaign did not decrease the high incidence of acquiring antibiotics without a prescription among Latinos in a South Carolina community. 2 Immigrants who had bought antibiotics without prescription in their home country were likely to continue this practice in the United States.…”