Online Pharmacies Add to Growing Antimicrobial Resistance Dangers

Dentistry Today


Dentistry accounts for approximately 10% of the antibiotics prescribed in the United Kingdom, according to the British Dental Association (BDA)—a problem that must be addressed as online pharmacies dispense antibiotics like candy, the BBC recently reported, and the threat of antimicrobial resistance (AMR) continues to grow.

Posing as a 16-year-old girl, general practitioner and BBC journalist Faye Kirkland, MBChB, got 3 antibiotics for 3 different conditions, including a “dental” problem, from a single doctor at one of the 17 websites she investigated within 24 hours. In fact, the site said she could choose from a selection of antibiotics, as if she—the alleged teenager—would know which was best.

The ease of acquiring antibiotics varied across the sites, though some offered discounts on the customer’s first order. In one case, doctors approved prescriptions in just 3 minutes. No phone call or face-to-face consultation was necessary. In some cases, the antibiotics that the online pharmacies prescribed weren’t even appropriate for the reported illness.

The General Medical Council in the UK has launched an investigation into the BBC’s findings. Also, the Care Quality Commission is now looking into introducing new rules next year to regulate online pharmacies.

“Our data comes from Google, and they say searches for people in the UK interested in buying antibiotics online have shot up 52% in the last 5 years. And they say that proportionally speaking, people in the UK are searching the web more than any other country in the world for antibiotics,” said Kirkland.

Patients in the UK are going online because general practitioners prescribed 2.5 million fewer antibiotics last year than they did the year before. Also, patients there may be having difficulty in getting timely appointments to see their doctors and dentists, or they may be embarrassed to see their physician, depending on the infection.   

“This BBC investigation highlights an urgent need to raise public awareness of AMR and the importance of seeing a dentist if people are concerned they might have a dental infection, rather than going online for antibiotics,” said Damien Walmsley, PhD, BDA scientific advisor.

The ADA reports that dentists prescribed 10% of the approximately 258 million courses of antibiotics administered in the United States in 2010. And while guidelines for most healthcare providers are in place, they may not be well promoted, understood, or followed.

“Patients may be surprised to learn that antibiotics won’t cure their dental abscesses, and analgesia is more often the treatment of choice for tooth-related pain,” Walmsley said. “It doesn’t help that some online pharmacies are dishing out antibiotics like Smarties for dental problems, which sends out completely the wrong message to patients.”

In September, the United Nations General Assembly held a special session to discuss AMR’s danger. For example, more than 200,000 infants die each year from infections that don’t respond to available antibiotics. Also, extensively drug-resistant tuberculosis has been identified in 105 countries.

Lord Jim O’Neill, who carried out a government review into AMR, warned that if effective controls aren’t put into place to curb inappropriate prescriptions, diseases that are resistant to antibiotics will overtake cancer as one of the leading causes of death in the world, with 10 million dead each year by 2050. The review recommended a 10-point plan to battle AMR.

“In our generation, we’ve grown up thinking these [antibiotics] are a miracle cure for anything. And they’re not, and we have to stop treating them like sweets, because the more we use them for the wrong things in the wrong doses and in the wrong way, the more resistant we become to them all, and we’re getting close to the age where none of them will work,” said O’Neill.

“The health risks presented by AMR require a change in gear from patients, practitioners, and policymakers,” said Henrik Overgaard-Nielsen, chair of the BDA’s general dental practice committee. “Dentists are willing to take responsibility for their share in combatting this risk.”

In 2015, the BDA published a consensus report drafted to promote awareness of AMR and help dentists reduce their use of antibiotics. The ADA also offers guidelines for dentists who want to enact and promote best practices for prescriptions.  

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