Illegal Antibiotic Dispensing by Online and Community Pharmacies in China: A National Cross-Sectional Study

Abstract

Background: Antibiotics are prescription-only medicines, and dispensing them without a prescription has been illegal in China since 2004. This study aimed to estimate the nonprescription supply of antibiotics by both online and community pharmacies in China. Methods: A nationwide, cross-sectional study involving online and community pharmacies was conducted from July 2017 to December 2018. A product-based simulated client method was employed to explore the nonprescription supply of antibiotics and the quality of online and community pharmacy services. Findings: In total, 220 online pharmacies and 675 community pharmacies were investigated. Illegal sale of antibiotics were found in 79·09% of online pharmacies and 86·81% of community pharmacies. Relative to online pharmacies with reminders about the illegal sale of prescription-only medicines, online pharmacies without such reminders were more likely to sell antibiotics without a prescription (P < ·001). The rate of nonprescription sales of antibiotics by pharmacies in provincial capital cities (71·56%) was significantly lower relative to that in prefectural-level cities (95·11%) and counties (93·78%). In addition, the quality of pharmacies services was poor in both online and community pharmacies. Interpretation: Illegal sales of antibiotics, a great threat to antibiotic stewardship, are common in both online and community pharmacies. Public supervision of illegal antibiotic sales reduces this problem to some extent but should be strengthened further. Moreover, health education regarding public antibiotic knowledge and improvement of the quality of pharmaceutical services in retail pharmacies should be improved. Funding: National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology. Declaration of Interest: We declare no competing interests. Ethical Approval: The study was approved by the Ethics and Human Subject Committee of Tongji Medical College. Considering the minimal risk of this study, and to obtain real results, the information about the investigation was not disclosed to the pharmacies and all data were kept anonymous.