Online antibiotic purchase in mainland China: A cross-sectional Simulated Patient study.

OBJECTIVE

This study aimed to assess the accessibility and regulatory compliance of online antibiotic sales in mainland China, a growing public health concern due to potential antimicrobial misuse and resistance.

STUDY

DESIGN

A descriptive cross-sectional survey.

METHODS

We conducted a descriptive assessment of eligible online antibiotic purchasing pathways on platforms accessible across mainland China from October 29, 2024, to March 31, 2025. Trained investigators, simulating patients with conditions not warranting antibiotic use (e.g., viral upper respiratory infections, pediatric cough, and pet illness), attempted to obtain antibiotics without prescription. Outcomes included dispensing without valid indication, consultation process characteristics, whether a prescription was displayed or issued, adherence to national 14-day supply limits, and platform accountability.

RESULTS

Antibiotics were dispensed in 92.6% of attempts (50/54) in scenario of human use of antibiotics, with 62.0% of prescriptions issued less than 3 s upon request. No platform required real-time video consultation or verified patient identity. Although some platforms collected self-reported allergy information, no verified or mandatory allergy screening prior to dispensing was observed. Half of prescriptions exceeded the national 14-day supply limit. The sales process of veterinary antibiotics, no veterinary pharmacy displayed professional qualifications and no other personal or animal health information was collected by any veterinary platform. Antibiotics can be purchased less than 3 s in all veterinary drug procurement scenarios, and no prescription or prescription audit procedures have been found.

CONCLUSIONS

In this simulated patient study, antibiotics were readily dispensed through nationally accessible online pharmacy platforms in China, including in clinically inappropriate scenarios, with limited observable safeguards. The findings highlight gaps in the regulation and stewardship of online antibiotic supply.