Fish Antibiotics Consumed by Consumers Seeking Cheaper Options

Patients seeking out the cheapest, fastest antibiotics have been consuming medication meant for fish instead of humans, according to research presented at ASHP’s 54th Midyear Clinical Meeting and Exhibition.

“This consumption may lead to dangerous unintended consequences such as adverse side effects, treatment failures, and antibiotic drug resistance,” said coauthor Brandon Bookstaver, PharmD, director of residency and fellowship training at the University of South Carolina College of Pharmacy in an ASHP press release.

The study consisted of investigating the misuse of the online fish antibiotic market via customer reviews and comments. Fish antibiotics are currently available over-the-counter and do not require a prescription, unlike medication intended for other animals like dogs and cats. 

A multitude of different medications are available on these websites with pricing, including $8.99 for a bottle of 30 capsules of amoxicillin (250 mg per capsule) to $119.99 for a bottle of 100 ciprofloxacin tablets (500 mg per tablet).

“While human consumption of fish antibiotics is likely low, any consumption by humans of antibiotics intended for animals is alarming,” Dr Bookstaver said in the press release. “Self-medication and the availability of antibiotics without health care oversight might contribute to increasing antimicrobial resistance and delayed appropriate treatment. We were particularly concerned that the high volume of positive feedback on the comments about human use might encourage others to attempt to use these drugs.”

Dr Bookstaver and colleagues found that comments related to human consumption of the antibiotics were 9 times more popular than any other comments on the websites; one comment stated the drugs were safe for human consumption. 

When Dr Bookstaver and colleagues obtained and examined the top five antibiotics marketed online for fish—amoxicillin, penicillin, cephalexin, metronidazole, and sulfamethoxazole-trimethoprim—they noted that the medications are the exact imprints, color, and shape of available products meant for human consumption. Further research is being conducted to verify the contents of the antibiotics.

“What might seem like a less expensive, easier way to treat an assumed infection can ultimately have very serious negative consequences,” said ASHP Director of Pharmacy Practice and Quality Michael Ganio, PharmD, MS, BCPS, CPHIMS, FASHP. “Unlike antibiotics for humans or other animals, these medications are completely unregulated by the Food and Drug Administration.” —Edan Stanley