Azithromycin Cefaclor Cefadroxil Cefdinir Cefixime Cephalexin Chloramphenicol Ciprofloxacin Clarithromycin Doxycycline Erythromycin Ethambutol Ethionamide Itraconazole Ivermectin Ketoconazole Levofloxacin Lomefloxacin Metronidazole Moxifloxacin Nitrofurantoin Ofloxacin Tetracycline Trimethoprim-Sulfamethoxazole

Sir, The past decade has seen increasing numbers of online pharmacies offering prescription-only medicines to patients. Many of these are reputable, dispensing medication only with a valid prescription from a health-care professional. Some offer an ‘online consultation’ usually consisting of a questionnaire detailing symptoms of the condition for which the medicine is sought as well as past medical history, other prescribed medications and allergies. The popularity of these online pharmacies seems to be increasing particularly among younger people who value the convenience of obtaining medicines in this way. However, as the number of Internet pharmacies has grown, so has the concern regarding the safety and quality of the medications dispensed. There are a large number of (usually non-UK based) web sites offering prescription-only medication including antimicrobials without a valid prescription. Very few of these web sites require patients to complete any type of health questionnaire detailing such relevant specifics as previous and concurrent illnesses and other medical history and allergies. Often the patient is not warned of the exact contents of the medicine, thus a penicillin-allergic patient may unwittingly purchase and consume medication containing this drug. These web sites fail to check and warn patients about the possibility of side effects and potentially dangerous drug interactions and also often fail to provide dosing schedules. Furthermore, there is no guarantee of the quality and effectiveness of the medications prescribed (sometimes being expired, contaminated or counterfeit and containing little or none of the active ingredients). There would be little or no legal redress in the event of an untoward event occurring. The risk of taking self-prescribed antimicrobials and other drugs is well documented. We were able to easily order all of the antimicrobials listed in Table 1 in a matter of a few minutes from various internationally based Internet pharmacies found using a popular search engine. None of them required any details regarding what the drug was intended to be used for, nor any past medical or allergy history. The process merely consisted of selecting the desired antimicrobial and quantity and completing payment by credit card. All of the web sites were registered outside the UK and presumably the medicines were to be shipped from international addresses. TheMedicinesandHealthcareproductsRegulatory Agency (MHRA) Enforcement team monitors the Internet for web sites dispensing prescription-only medicines to patients without a valid prescription. Table 1 Antimicrobials available to purchase without valid prescription