Abstract
INTRODUCTION: The illegal sale of antibiotics through online pharmacies (OPs) can lead to misuse and poses major health risks, because drug quality and authenticity are not ensured. This study was aimed at investigating the extent of illegal online antibiotic sales from both local and international OPs. MATERIAL AND METHODS: A mystery shopper study was conducted on topical clindamycin, oral amoxicillin, and amoxicillin/clavulanic acid. A search term for each antibiotic in both English and Arabic was used to search Google, Bing, and Yahoo. The first 20 results were obtained, examined, and evaluated according to predetermined criteria. Purchasing was performed according to a systematic approach, to explore whether OPs would sell antibiotics without valid prescriptions, accept outdated prescription, or reject sales. RESULTS AND DISCUSSION: At the 60 OPs identified, 22 purchases were made, and ten products were successfully delivered, all from local OPs. Some international OPs requested Bitcoin payment and therefore appeared to be potential scam websites. A substantial number of OPs did not adhere to regulatory requirements, and 33.3 % (20 of 60) did not request prescriptions. Among those OPs, 45 % (9 of 20) were fake, and 45 % (9 of 20) sold topical clindamycin. Whereas 96.7 % of OPs provided contact details, only 13.3 % had quality certifications. Return policies were displayed by 85 % of OPs, and 88.3 % displayed drug information and related warnings, including adverse effects and interactions. CONCLUSION: Our findings underscore the urgent need for stricter regulations and enhanced monitoring of OPs. However, searching of the dark web, which is known to have illegal marketplaces offering prescription drugs, particularly antibiotics, was not investigated.