A study of antibiotics marketed for fish online found user comments about human use garner nine times as much attention

New research has found that some Americans are probably taking fish antibiotics as a substitute for going to the doctor, which can be prohibitively expensive for many in the US.

Unlike other antibiotics, fish antibiotics are readily available without a prescription online and are relatively inexpensive as anti-bacterial drugs for pet fish.

Researchers analyzed reviews for fish antibiotics available online, and found a small but significant percentage of consumers reviewed the antibiotics for human use.

In addition, at least five of the antibiotics marketed for fish that researchers looked at had the exact imprints, colors and shapes of antibiotics for humans, which could encourage people to use them.

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“While human consumption of fish antibiotics is likely low, any consumption by humans of antibiotics intended for animals is alarming,” said Brandon Bookstaver, a pharmacist and director of residency and training at the University of South Carolina College of Pharmacy.

Bookstaver co-authored the research, which was presented at the American Society of Health-System Pharmacists (Ashp) semi-annual conference in Las Vegas, Nevada, in December.

“Self-medication and the availability of antibiotics without healthcare oversight might contribute to increasing antimicrobial resistance and delayed appropriate treatment,” Bookstaver said. “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.”

Researchers found nine antibiotics for sale at 24 different websites, including some of the most commonly prescribed to humans, such as penicillin and amoxicillin. Only 55 of the 2,228 comments reviewed described human use, but garnered nine times as much attention as others through “likes” and “dislikes”.

Additionally, at least one online seller responded to an online question, saying fish antibiotics were suitable for human use.

There is also anecdotal evidence Americans are increasingly taking veterinary medicine. Dr Farzon Nahvi, an emergency room doctor in New York City and a member of Physicians for a National Health Program, said he had a patient overdose on fish antibiotics.

“One of my patients took fish antibiotics because she didn’t have health insurance,” said Nahvi. “She overdosed, ended up in the intensive care unit, and ended up far more ill and – having no insurance – with an even bigger bill. Plus, she missed a job interview, which could have been her ticket to health insurance, because of her hospital stay.”

At least 27 million Americans have no access to healthcare at all, because they lack health insurance. In addition, polls have shown one in four Americans who take medications struggle to afford them, according to Kaiser Family Foundation.

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Unlike in the UK, where patients may have a modest out-of-pocket payment determined by the National Institute for Health and Care Excellence, American patients have sometimes enormous costs in the US. Americans pay more for pharmaceuticals than anywhere else in the world.

“Humans taking fish antibiotics doesn’t seem to be a specific problem that can be addressed with a specific solution or single law like one increasing the regulation of fish antibiotics,” said Nahvi. “This simply seems to be a symptom of the much larger issue of a broken healthcare system, where people who are excluded from the system are looking for solutions outside of it, sometimes to dangerous effect.”