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You Can’t Buy Antibiotics Over The Counter, Can You? (Yes, You Can.)

In yesterday’s post analyzing the Food and Drug Administration’s report on sales of antibiotics for use on farms in 2014, I noted that almost 99 percent of the antibiotics sold for agricultural use are sold over the counter, that is, without a prescription.

The FDA is attempting to change this, via an updated rule called the Veterinary Feed Directive; once that rule is finalized, livestock producers should only be able to obtain antibiotics once they have an “order” from a veterinarian. The goal here is to build more accountability into antibiotics purchase and use, because any misuse creates the possibility of resistance; and there is more use of antibiotics in agriculture, by sheer volume, than in human medicine.

As often happens when I talk about this, I ran into some disbelief: people protesting that, come on, surely you can’t just walk into a store and buy antibiotics, can you?

Almost 99 percent (sum of the yellow boxes) of the antibiotics sold for use in food animals in the US are sold over the counter, that is, without a prescription.
Almost 99 percent (sum of the yellow boxes) of the antibiotics sold for use in food animals in the US are sold over the counter, that is, without a prescription.
Graphic from the ADUFA 2014 report, Table 6; original here.

In response, I posted a picture of two pounds of aureomycin (generic name, chlortetracycline) that I bought online without anyone asking me anything except my credit card number.

Simultaneously, Twitter follower Jonathan Sellman, MD, an infectious diseases specialist in the Twin Cities who heard me discuss this on MPR News with Kerri Miller, grew impatient with a caller who didn’t believe this happens, and decided to demonstrate that it does. He went down to a local farm-supply store, photographed several shelves full of antibiotics, and tweeted the images. He was soon backed up by Tim Johnson, PhD, a professor who researches antibiotic resistance, and by Peter Bornstein, MD, MBA, another infectious diseases physician; they both contributed images and links.

Up top, I’ve put together a quick slideshow. The answer to the question, Is it really as easy as it seems to buy antibiotics over the counter, and to use them without anyone looking over your shoulder to make sure you use them correctly?, is: Yes, actually, it is. Click through to see what we found.

One thought on “You Can’t Buy Antibiotics Over The Counter, Can You? (Yes, You Can.)

  1. I don’t know whether attacking feed supply stores is appropritate for the large antibiotic issue. They aren’t the ones mass-producing animals. You need to talk to the large agro-corps like Tyson, they certainly aren’t running their reps over to the local feedlot to buy 20-gallon antibiotic power mixes. They’re more likely to be buying their drugs directly from the manufacturers. They control their “farmer-owned” lots to the extent that they can dictate what feed to give them and how much light they *need*, so I rather doubt the farmers have independent control on the antibiotics either.

    Look at this from the perspective of someone who keeps a small flock of hens or a small backyard type farm. (I, myself, keep chickens and guinea pigs, and have had to only make a few purchases of feedlot antibiotics to counter a course of wet tail.) Feedlot antibiotics are important to us, we certainly aren’t dosing our animals daily because we, for the most part, take care of them and don’t keep them in filthy conditions where they have to be medicated to survive.

    I understand the reasonableness of wanting a “veterinarian prescription” for antibiotics, but bear in mind there aren’t enough “exotic” vets who will treat a herd of guinea pigs at a farm-level cost (or chickens, or goats or horses or whatever). The average ticket here just for a vet clinic *visit* with a single guinea pig is $45 plus labwork (+$25), plus whatever medications they decide to prescribe (+$15-$50), and no they won’t just write the script out for me to get it somewhere cheaper. Having a veterinarian give me a prescription for some clotrimazole and bacitracin cream for a SINGLE animal came to the total of $90. I had four new guineas under quarantine that’d all come in with ringworm. The vet refused to prescribe enough for everyone based on the one animal, with the other three showing exact same symptoms, from the same originating breeder. Nope, they wanted a sweet $360 check from me. You’re darn right I went to the feedlot and bought the cream I needed for everyone $25, and in a week they were all recovering well, and the left-over cream was disposed of. I sell my guinea pigs as $20 pets, the medical price so severely outweighs what the animal is worth that it’s more cost effective for me to cut my loss and cull rather than treat a minor and merely annoying infection through veterinarians.

    A recent brush with the same issue left a lot of us unable to buy kaolin pectate from feedlots because it was considered a “prescribeable medication”. Ivermectin I’d understand, fembendazole I would too, nystatin even. But kaolin pectate? (The best product for controlling animal diarrhea ever.) The attendant mentioned another customer who’d lost a foal to some form of colic behind a nearby vet not considering the issue to be an emergency and suggested that the animal be driven to their clinic in a suburban area for examination. And once there, no one really knew how to handle a baby horse. The breeder knew what they needed to buy, they’d been raising gaited horses for 30 years before that, but at the time was unable to obtain what they needed and couldn’t cobble together a replacement from an OTC drugstore purchase.

    The problem you’re describing in antiobiotic resistance isn’t coming out of feedlot antibiotics, albeit I’m sure it doesn’t help if they aren’t dosed responsibly. They’re supplying small-fry farmers and animal breeders who try to actually maintain their stock without excessive antibiotics because the animals aren’t “worth” enough to constantly pump medications into them. Throwing veterinarian costs into that market are not going to make antibiotic use more responsible in that area, it’ll just remove the use entirely, to the detriment of the locals. The responsible parties are those who can somehow afford to keep 2,000 head of pigs in nose-to-tail warehouse conditions because they make their money on the quantity of meat that they move, not the quality of the same.

    MM: This is really thoughtful insight and I’m grateful that you posted it!

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