Antibiotics Bought Easily on the Internet
TUESDAY Sept. 15, 2009 -- Consumers who decide on their own that they need antibiotics can easily find and buy the medications on the Internet, without the benefit of a prescription, new research shows.
The practice is illegal, the study authors said, and could contribute to an overuse of antibiotics that is known to create resistant bacteria which, in turn, can cause life-threatening infections.
One expert agreed the trend has troubling implications.
"The expanded and uncontrolled use of antibiotics is a public health hazard because of the impact on creating multiple drug-resistant bacteria," said Dr. Robert Schwartz, chair of the department of family medicine and community health at the University of Miami Miller School of Medicine. "We already have a problem in our country with physicians overprescribing antibiotics . . . Allowing individuals in society unrestricted access to antibiotics is a set-up for a public health disaster."
Most previous research and attention has focused on overprescribing by doctors, said Arch G. Mainous III, lead author of a paper appearing in the September/October issue of the Annals of Family Medicine.
"Unfortunately, it's misleading to make the assumption that that's only where antibiotics are available," he noted.
Not only are antibiotics available without a prescription in many other countries, they are also available in the United States at, for instance, cornerstores that serve ethnic communities, he said.
In the study, Mainous, a professor of family medicine and biostatistics, bioinformatics and epidemiology at the Medical University of South Carolina in Charleston, and his co-authors searched "purchase antibiotics without a prescription" on both Yahoo and Google, focusing only on English-language sites.
The search yielded 138 different sites that sold antibiotics without a prescription -- 36.2 percent required no prescription at all, while 63.8 percent were set up to provide an online prescription.
Some of the Web addresses were linked with servers at prestigious educational institutions in the United States, including Dartmouth College, Carnegie Mellon University and the University of Pittsburgh, without those institutions' knowledge.
Almost all (98.6 percent) shipped to the United States.
When the researchers actually ordered different antibiotics, they found that the mean delivery time was eight days, meaning that most arrived after the buyer should have already recovered from his or her illness.
"One order came in 28 days from the day we submitted the online purchase," said Mainous. "By then, either you're hospitalized or it's going away."
Sites also tended to sell quantities far in excess of what you would need for one course with a prescription, often with the same shipping cost for a small or large order, Mainous said.
And were the antibiotics always the drugs these online sellers claimed they were? The study authors weren't sure. "We could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated," they wrote.
Consumer education is probably not enough to solve the problem, given that people tend to repeat familiar behaviors, Mainous said.
U.S. regulatory agencies need to step up their efforts to enforce existing laws, according to the study authors. Pharmaceutical companies also need to keep on top of where their products are selling.
"If it's freely available, then I think you're going to see much more self-medication and much more self-diagnosis, with very little control," Mainous said.
The study didn't investigate how many people were actually buying antibiotics off the Internet, but Mainous has found that as many as 20 percent to 30 percent of people in immigrant communities in the United States are obtaining antibiotics at local bodegas.
"Consumers should consult with their primary-care providers first before ordering antibiotics and ask for advice," Schwartz recommended. "Many people will take antibiotics for viral infections, which of course are useless and have potential negative side effects -- destroying normal gut flora, allowing potentially harmful bacteria that are stable under normal conditions to become pathogenic or harmful. They should save their money."
The Alliance for the Prudent Use of Antibiotics has more on the dangers of antibiotic overuse.
Posted: September 2009
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