Kaur Puneet, Kaur Navjot, Kaur Jasmeen, Kaur Manvir, Singh Jasbir
Pharmacology, Government Medical College, Patiala, IND.
Public Health, Johns Hopkins Bloomberg School of Public Health, Maryland, USA.
Cureus. 2025 Aug 7;17(8):e89577. doi: 10.7759/cureus.89577. eCollection 2025 Aug.
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.
引言 全球抗菌药物耐药性（AMR）的上升对公共卫生构成了严重威胁，降低了常用抗生素对常见细菌感染的疗效。印度电子药房的迅速增加，尤其是在新冠疫情期间及之后，改善了公众获取药品（包括抗生素）的途径。然而，获取的便利性加上电子药房监管框架的不明确，可能会无意中鼓励抗生素的不合理使用。尽管人们越来越关注这一问题，但印度在线销售抗生素的可得性数据却很匮乏。同样，对于影响抗生素安全合理使用的关键特征，缺乏对电子药房的比较分析。
方法 本研究旨在评估在线销售抗生素的可得性，并比较电子药房在影响抗生素安全合理使用的关键特征方面的情况。进行了一项为期六个月的横断面研究，使用《2022年国家基本药物清单》和世界卫生组织-“AWaRe”（获取、观察、储备）分类法，评估50家印度电子药房抗生素的在线可得性。在全面审查现有文献后，编制了三份定制问卷，即“电子药房特征”问卷、“抗生素产品信息充分性”问卷和“消费者意识信息”问卷。这些工具用于收集有关以下参数的信息：a）电子药房的安全性和真实性，b）充足药品信息的可得性，以及c）网站上关于安全合理使用抗生素的消费者意识信息。由于数据在公共领域可得，因此未寻求伦理批准。使用描述性统计进行数据分析。
结果 共研究了17种抗生素。世界卫生组织-“AWaRe”所有类别的抗生素都有在线销售，其中“观察”类抗生素占主导，其次是“储备”类和“获取”类。没有一家电子药房完全符合三份问卷中概述的参数。在遵守这些参数方面观察到了相当大的差异。例如，虽然大多数电子药房有客户支持/投诉解决政策（90%），并且抗生素销售需要处方（82%），但没有一家提及负责回答问题的药剂师的注册状态，也没有采取措施防止过量的抗生素订单。
结论 “观察”类和“储备”类抗生素获取途径的增加可能导致其过度使用，这可能会加剧抗菌药物耐药性的增长。研究结果凸显了对电子药房建立严格监管框架的必要性，并强调了消费者教育在安全合理使用抗生素方面的重要性。
