Obtaining antibiotics online from within the UK: a cross-sectional study.
Improved antibiotic stewardship (AS) and reduced prescribing in primary care, with a parallel increase in personal internet use, could lead citizens to obtain antibiotics from alternative sources online.



A cross-sectional analysis was performed to: (i) determine the quality and legality of online pharmacies selling antibiotics to the UK public; (ii) describe processes for obtaining antibiotics online from within the UK; and (iii) identify resulting AS and patient safety issues.



Searches were conducted for 'buy antibiotics online' using Google and Yahoo. For each search engine, data from the first 10 web sites with unique URL addresses were reviewed. Analysis was conducted on evidence of appropriate pharmacy registration, prescription requirement, whether antibiotic choice was 'prescriber-driven' or 'consumer-driven', and whether specific information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase.



Twenty unique URL addresses were analysed in detail. Online pharmacies evidencing their location in the UK ( n  = 5; 25%) required a prescription before antibiotic purchase, and were appropriately registered. Online pharmacies unclear about the location they were operating from ( n  = 10; 50%) had variable prescription requirements, and no evidence of appropriate registration. Nine (45%) online pharmacies did not require a prescription prior to purchase. For 16 (80%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, dose and quantity.



Wide variation exists among online pharmacies in relation to antibiotic practices, highlighting considerable patient safety and AS issues. Improved education, legislation, regulation and new best practice stewardship guidelines are urgently needed for online antibiotic suppliers.
Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.|National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Sara Elizabeth
SE
Boyd
Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.|National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Luke Stephen Prockter
LSP
Moore
Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.|National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Mark
M
Gilchrist
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Ceire
C
Costelloe
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Enrique
E
Castro-Sánchez
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.|Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK.
Bryony Dean
BD
Franklin
Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.|National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK.
Alison Helen
AH
Holmes
D000900:Anti-Bacterial Agents; D000073602:Antimicrobial Stewardship / Q000331:legislation & jurisprudence / Q000592:standards; D003430:Cross-Sectional Studies; D006801:Humans; D020407:Internet; D060946:Pharmaceutical Services, Online / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D055553:Prescription Drugs