For years, doctors warned people would die if we didn’t stop taking so many antibiotics. Now it’s happening. So why ARE online chemists still doling them out like sweeties?
ANN STRUTHERS was 18 and in her first year at college when she came down with a sore throat. Her mother, Dee, a 60yearold former nursery nurse, wasn’t worried. ‘We just thought it was a normal bug — you take painkillers, you gargle, you get better,’ she says.
But, tragically, little more than two weeks later, Ann, a ‘generous, kind, thoughtful girl’, died of sepsis in hospital on the Isle of Man, after 11 days there. Not one of the 11 antibiotics in seven combinations that were given intravenously could stop the infection’s path.
‘Even a couple of days before she died, we still hoped she would survive,’ says Dee. ‘You never give up hope. At the time, the doctors didn’t say anything about antibiotic resistance — they just said she wasn’t responding.’
Eventually, her parents had to make the awful decision to switch off the machines keeping her alive. Normally fit and healthy, Ann hadn’t been a prolific antibiotic user, but her infection, which turned into pneumonia, proved resistant to even the most powerful drugs.
Antibiotic resistance — infections that won’t respond to traditional medical treatment, leading to sepsis, which can cause total organ shutdown — has become a growing health crisis. Sepsis is said to kill 44,000 people in the UK every year — and at the heart of the problem is the overuse of antibiotics.
Some 34 million prescriptions for antibiotics are made each year in Britain. So prolific is our use that bacteria are evolving to resist the drugs, rendering many strains untreatable. And the more antibiotics are used, the stronger superbugs become.
But it’s not just their use in hospitals that we have to worry about. Having antibiotics delivered to your door via the internet is now almost as simple as ordering a pizza, a Daily Mail investigation found.
In under 24 hours, for as little as £10, we were able to order a selection of antibiotics, including trimethoprim, used to treat the bladder infection cystitis, as well as penicillin and antibiotic eardrops. At no point did we have to speak to a GP or pharmacist.
We have all come to take antibiotics for granted: their global use has soared by almost 40 per cent in the past 15 years. Few of us can imagine life without them. Yet senior figures fear we may soon have to, as they become increasingly ineffective. England’s chief medical officer, Professor Dame Sally Davies, warned in 2015 of the dangers of antibiotic resistance, painting an apocalyptic picture.
She has described a world where routine hip or knee replacements are impossible, as there are no antibiotics to protect against infection. Cancer patients would be left without drugs to shield them from potentially deadly bugs, while their immune systems are wiped out by chemotherapy. Organ transplantation could become a thing of the past.
Former Tory minister Lord Jim O’Neill led a threeyear review into these dangers. His conclusion in 2016 was that superbugs could kill 10 million people a year worldwide by 2050 if appropriate action was not taken.
The World Health Organisation has made tackling the issue a top priority, while GPs have been urged to refuse antibiotics for minor complaints such as sore throats. The Department of Health introduced a sore throat ‘test and treat’ programme in 2016, where pharmacists test a throat swab to see if patients do need antibiotics.
All of this came too late for Ann. Her parents Dee and John, a 58 year old nurse turned hospital manager, followed the accepted advice when she started to feel unwell at a family wedding in 2013. They didn’t rush to the doctor, but instead made sure she got plenty of rest and offered lots of fluids and painkillers.
By the end of the week, however, she was showing symptoms of flu. When Ann complained of chest pain, with a racing pulse, shallow breathing and a low temperature, her mum took her to A&E, where her pain was put down to muscle ache from coughing.
But that night at home, she grew worse and started hallucinating. Dee and John rushed her to hospital.
‘Within 20 minutes, they told us we had a very sick daughter. They started her on antibiotics and began pumping fluid into her,’ says Dee. Initially, Ann was well enough to sit up in bed and eat — but she deteriorated.
SHE was put in a medicallyinduced coma to ease her discomfort while doctors fought the infection. Yet it developed into pneumonia and remained resistant to antibiotics.
The family have set up a charity, Mannin Sepsis ( manninsepsis.com), to aid detection.
‘Nothing can bring our daughter back, but we can do a positive thing in Ann’s memory,’ says Dee.
But, while families and experts fight to raise awareness of antibiotic overuse, their efforts are undermined by the availability of drugs online.
Antibiotics are prescriptiononly medicines in the UK, so cannot legally be sold without a valid prescription.
The sites we found offering them are not technically breaking the law, as they do issue a prescription, which, they say, has been approved by one of their own registered doctors.
Nor are they foreign websites, largely unregulated by UK authorities. All the drugs came from online medical providers registered with UK bodies that vet and approve such services, including the Care Quality Commission (CQC), Medicines and Healthcare products Regulatory Agency, General Medical Council (GMC) and General Pharmaceutical Council.
The drugs we purchased, for prices ranging from £10 to £30, were all dispensed after completing a few simple online medical questionnaires. But with no access to our medical history, they relied on us giving accurate answers. And there was nothing to stop someone going back and changing their answers if their original responses didn’t result in a prescription for antibiotics.
We attempted to order from nine online providers of GP and pharmacy services registered with the CQC in England which offer antibiotic prescribing (not all online pharmacies do). You find the condition you believe you have and the site takes you through a series of medical questions (which varied from site to site).
The conditions we enquired about were problems GPs usually only treat with antibiotics after carrying out a physical examination: acute tonsillitis, cystitis, an ear infection and bacterial vaginosis ( a genital infection in women). The site then issued what it felt were the appropriate medicines.
Some companies — namely Boots and Oxford Online Pharmacy — refused to dispense antibiotics without an NHS prescription from a GP through the post. Others, such as White Pharmacy, rejected antibiotic treatment as inappropriate and recommended seeing a doctor.
But several readily issued the drugs. Some allowed patients to request a video or telephone consultation, but there was no obligation to do so.
Take the website i-GP, whose CEO is a doctor with more than 15 years of NHS experience. To treat a sore throat, i-GP charged £10 for phenoxy-methylpenicillin (28 x 500mg), widely used to treat acute tonsillitis.
Questions asked included whether tonsils were swollen. Many bacteria have developed resistance to this drug, so it’s crucial that it is used only in patients with infections that will respond to treatment.
The i-GP website did not respond to a request for comment.
Another site, Zavamed (previously DrEd), suggested treating a genital infection with metronidazole (£24.99, plus £3.99 delivery, for 14 x 400mg), an antibiotic that must not be combined with alcohol.
Dr Sara Boyd, a clinical fellow in infectious diseases and microbiology at Imperial College London, says: ‘[Alcohol] can stop the drug from working properly and have serious sideeffects, from dizziness to breathlessness and an irregular heartbeat.
‘I’m not sure that message comes across as well if you buy drugs online as it does when a doctor or pharmacist tells the patient to their face.’
The Zavamed website carries such a warning, but it’s listed among drug details, rather than being flagged up when you order. When the pack arrived, it carried a warning, but in tiny print on the dosage label.
Dr Louisa Draper, medical director for Zavamed, said the company uses
a complex computer algorithm to detect when patients might be lying and nearly a third of applications for some antibiotics are rejected. ‘This one probably slipped through the net,’ she says. ‘We had an outstanding report from the CQC last summer.’
In a third case, WebMed Pharmacy recommended paying £ 20 for trimethoprim (6 x 200mg) to treat cystitis. It requested details of symptoms and asked if the patient had previously had cystitis — if not, they were advised to see their GP.
NHS England has, in recent years, offered financial incentives for GPs to cut prescribing of trimethoprim for urinary infections, due to fears of growing bacterial resistance. WebMed Pharmacy said it relies on patients being honest when filling in online medical questionnaires.
Margaret Hudson, a pharmacist with the company, said: ‘We feel we provide a very good service. Most people are very honest, but we have no way of checking whether they are telling the truth.’
THE final pharmacy to offer antibiotics was The Online Clinic, whose founder, Robert MacKay, is an entrepreneur and investor, according to his social media.
The site suggested Betnesol-N for an ear infection (£29.95 for 10ml). These ear drops contain a steroid, betamethasone, and neomycin sulphate, an antibiotic.
Mr MacKay said: ‘Online forms as the basis of a consultation are recognised by the various regulatory bodies that oversee the sector. The prescription was considered by two GMC-registered doctors (one did the consultation and another checked the clinical information again prior to issuing a prescription). We consider this to have been a robust process.’
The GMC, which regulates the profession in the UK, says buying drugs online may be convenient. But convenience cannot be at the expense of safety. A spokesman said: ‘Doctors’ obligations to their patients do not change because the consultation is online. We take any concern linked to inappropriate prescribing very seriously.
‘Our prescribing guidance makes it clear that doctors may prescribe only when they have adequate knowledge of the patient’s health and are satisfied the medicines serve the patient’s needs.’
Yet Mark Fielder, a professor of medical microbiology at Kingston University London, says: ‘I don’t think it should be possible to buy antibiotics online. We need to protect the drugs we have left and ensure they are used at the right time and against the right organism or the resistance issue will get worse. The picture is fairly bleak.’
Consider the experience of Kelly Strudwick, a healthcare assistant and mother- of-two from Kent, who was left fighting for her life in August 2012. She had been plagued by urinary tract infections for two years and regularly took antibiotics. But one particular infection just wouldn’t go away.
When many types of antibiotics failed, Kelly was sent to hospital.
Within two weeks, she was in intensive care. The infection had spread and caused sepsis. She began hallucinating — her parents and fiance were warned she might not make it through the night.
BUT Kelly was lucky. Over the next ten days, she began to recover as the infection finally responded to treatment. Tests revealed her infection was caused by a form of E.coli responsive to just one intravenous antibiotic.
According to a U.S. study, the number of urinary tract infections caused by antibiotic-resistant bacteria increased by 50 per cent between 2000 and 2009.
Now 29, Kelly still suffers from bladder infections and has to have prompt IV treatment. ‘It’s not as straightforward as taking tablets, but at least I know I am getting the right antibiotics,’ she says.
Another fit young person who was almost killed by antibioticresistant bacteria is Ben May, 25.
He was in his third year of an engineering degree at Oxford University in 2014 when he injured his knee playing football. He signed a disclaimer that mentioned a one in 200 chance of developing an infection and had routine surgery to replace a damaged ligament.
Ben, from Haslemere, Surrey, contracted the superbug MRSA. He began to feel ill two weeks after surgery. ‘It was like the most awful flu I’d ever had, times ten,’ he says. In hospital, his wound was cleaned and he was given antibiotics.
When tests showed he had MRSA, he was given intravenous drugs.
Over the next three months, he spent 44 days in hospital and lost almost 3 st. He ended up on super-strength antibiotics. ‘It was described as putting Domestos through your veins to ensure the infection stopped,’ he says.
By the time he had his final surgery in July 2016 to reconstruct his damaged knee, Ben had undergone eight operations. ‘I never really thought it was too serious,’ he says. ‘But, looking back and hearing other stories, it does make you aware of your own mortality.’
That’s something many more people might face unless we, as a nation, curb our antibiotic ‘habit’.