Assessment of Availability of Antibiotics for Online Sale and Comparison of E-pharmacies in India.

Introduction The global rise in antimicrobial resistance (AMR) poses a serious public health threat, reducing the effectiveness of commonly used antibiotics against prevalent bacterial infections. The mushrooming of Indian e-pharmacies, especially during and after the COVID-19 pandemic, has improved public access to medicines, including antibiotics. However, the ease of availability, combined with an ambiguous regulatory framework governing e-pharmacies, may inadvertently encourage the irrational use of antibiotics. Despite this growing concern, there is a paucity of data on the availability of antibiotics for online sale in India. Similarly, there is a lack of comparative analysis of e-pharmacies on key characteristics influencing safe and rational use of antibiotics. Methods The present study aims to assess the availability of antibiotics for online sale and compare the e-pharmacies on key characteristics influencing safe and rational use of antibiotics. A cross-sectional study was conducted over a six-month period, assessing 50 Indian e-pharmacies for the online availability of antibiotics, using the National List of Essential Medicines, 2022 and WHO-AWaRe (Access, Watch, Reserve) classification. Three customised questionnaires, namely, 'E-Pharmacy Characteristics', 'Adequacy of Antibiotic Product Information' and 'Consumer Awareness Information' questionnaire, were developed after a thorough review of available literature. These tools were used to collect information on parameters pertaining to a) safety and authenticity of e-pharmacies, b) availability of adequate drug information, and c) consumer awareness information available on websites for safe and responsible use of antibiotics. Ethical approval was not sought as the data were available in the public domain. The data analysis was conducted using descriptive statistics. Results A total of 17 antibiotics were studied. Antibiotics from all WHO-AWaRe categories were available for sale online, with a predominance of 'Watch' category antibiotics, followed by 'Reserve' and 'Access' categories. None of the e-pharmacies fully complied with the parameters outlined in the three questionnaires. Considerable variation was observed in their adherence to these parameters. For instance, while the majority of e-pharmacies had a customer support/grievance redressal policy (90%) and required a prescription for antibiotic sales (82%), none mentioned the registration status of the pharmacist responsible for answering queries or had measures in place to prevent excessive antibiotic orders. Conclusion Increased access to 'Watch' and 'Reserve' antibiotics may contribute to their overuse, which may potentially fuel growing AMR. The findings highlight the necessity for a stringent regulatory framework for e-pharmacies and emphasize the importance of consumer education on the safe and responsible use of antibiotics.