In the antimicrobial stewardship area, there are things that are so easy to address (‘low hanging fruit’) but have received surprisingly little attention. Over-the-counter (OTC), including internet, purchases of animal antibiotics for use in people occurs in some regions. (In Canada, you could buy a variety of antibiotics for fish OTC in any pet store until a couple years ago.) While the role of this in resistance pales compared to various other issues, it’s still something to address.
You might say “so what….does it really matter if someone uses a fish antibiotic”
Well…yes…because those antibiotics are the exact same as those used in people. People will sometimes buy antibiotics marketed for fish and give them to themselves, usually with dosing instructions from the internet. It’s exceptionally difficult to figure out how often this is done and what harm is done.
A recent study in PlosOne (Zhang et al) looked at the availability of OTC antibiotics on internet sites from the US, and tried to infer information about purchase for self-medication. They did that by looking at comments and ‘likes’ that the comments received.
- Not surprisingly, various antibiotics were available: amoxicillin cephalexin, metronidazole, ciprofloxacin, penicillin, clindamycin, doxycycline, erythromycin and trimethoprim-sulfa.
- 2.4% of overall comments and reviews for drugs on these sites were potentially associated with human use. Comments about human use received a lot more ‘likes’….9.2 per review vs 0.5 for those not related to human use.
- The antibiotics that had the most human use related reviews were erythromycin (8.3%), clindamycin (5%), ciprofloxacin (3.4%), penicillin (3.3%) and doxycycline (2.8%).
- The greatest number of ‘likes’ was for ciprofloxacin (ugh…).
While I assume there was some subjectivity determining what constituted human use, a few examples they provided were pretty clear, such as:
- I don’t have health insurance and needed to get rid of an STD
- Works just the same as pharmaceutical ciprofloxacin. No difference that I could tell. Will be getting more.
- Since antibiotics are so difficult to find without a prescription, this is a great buy for human, animal and fish.
There is absolutely, positively no reason for someone to be able to buy ‘animal’ antibiotics over the counter, without medical advice.
Low hanging fruit need to be picked from both regulation and enforcement standpoints.