New ways to obtain antibiotics – a threat to antimicrobial stewardship?

Talk Code: 
Benedict Hayhoe
Benedict Hayhoe, Geva Greenfield, Azeem Majeed
Author institutions: 
Department of Primary Care and Public Health, School of Public Health, Imperial College London


Antimicrobial stewardship (AMS) initiatives are reducing inappropriate prescribing of antibiotics in primary care. However, such initiatives are undermined by increasing availability of new routes to obtaining antibiotics, including alternatives to face-to-face consultations, and the sale of antibiotics online without medical assessment.


We reviewed existing published evidence and publically available data to understand the likely impact of new ways to obtain antibiotics.


1. A lower threshold for prescribingAlternatives to face-to-face consultations, including telephone and internet-based consultations, are becoming more common, both in NHS primary care and in the private sector. Inability to examine patients, limitations in information gathering, reduced availability of diagnostic testing, and increased time pressure in non-face-to-face consultations may all contribute to a lower threshold for prescribing antibiotics. Limited existing evidence suggests that clinicians are more likely to prescribe antibiotics via telephone or video consultations than when seeing patients with the same conditions face-to-face.2. Sale of antibiotics online without prescriptionAntibiotics are increasingly available without a prescription via online retailers based outside the UK. The lack of any medical assessment increases the likelihood of inappropriate use, and puts patients at risk of missed or delayed recognition of important diagnoses. There is also a risk of obtaining poor quality or counterfeit medications. EU data suggest that online sale is not currently a significant source of antibiotics for patients. However, the impact of online availability may be greater in the UK than in other EU countries where significant over-the-counter sale of antibiotics takes place.


Alternatives to face-to-face consultations in primary care may lead to easier availability of antibiotics through a lower threshold for prescribing. Research is needed to quantify the extent of such prescribing, but further implementation of these consultation types should consider their potential to increase inappropriate prescribing.The sale of antibiotics online without medical assessment is likely to increase inappropriate use, while exposing patients to significant risk. Regulators must work with government to find solutions, including legislation, to the problem of online pharmacies selling antibiotics without medical assessment.

Submitted by: 
Benedict Hayhoe
Funding acknowledgement: 
This research was supported by the Imperial NIHR Biomedical Research Centre and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Northwest London (NIHR CLAHRC NWL). The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.