As antimicrobial resistance (AMR) accelerates into one of the world’s most serious public-health threats, the rapid expansion of online medical consultations has raised new concerns about how antibiotics are prescribed in digital care settings. Online medical consultation services, including app-based or telephonic platforms, have grown rapidly in recent years in India, providing patients with convenient access to clinicians and medicines through phone calls, video calls, or chat. These services can improve accessibility for routine care, preventive follow-ups, and management of chronic conditions, especially in areas with limited physical healthcare infrastructure, but also have another danger.
However, anecdotal and emerging reports suggest that some online consultations may lack comprehensive clinical assessment, particularly when consultations are brief or conducted via audio only.
A recent LinkedIn post by Dr. Vishal Gabale, specialist in internal medicine and medical educator, described an informal experiment in which a high-tier antibiotic, levofloxacin was prescribed within minutes on an audio-only consultation without documented history taking, symptom evaluation, or clinical examination.
According to his report, the clinician asked only for the patient’s name and diagnosis before issuing the prescription, without assessing symptoms, comorbidities, medication allergies, or potential red flags.
While this account reflects one individual experience, it highlights broader concerns in medical practice and digital health: the risk of antibiotics being prescribed prematurely or inappropriately when thorough clinical evaluation is not performed, or when speed and convenience take precedence over standard diagnostic processes.
Antibiotics are among the most commonly prescribed drugs worldwide and are essential in treating bacterial infections. Certain classes, such as fluoroquinolones like levofloxacin, are classified under Schedule H in India, indicating that they should be dispensed only with a valid prescription due to potential side effects and the risk of misuse.
The World Health Organization (WHO) identifies antimicrobial resistance (AMR), including resistance to antibiotics, as one of the top 10 global public health threats facing humanity. AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medications, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
According to the WHO:
Misuse and overuse of antibiotics are major contributors to the development of drug-resistant pathogens.
Resistance increases the risk that common infections will become untreatable with existing drugs.
AMR contributes to prolonged hospital stays, higher medical costs, and increased mortality.
The most recent WHO fact sheet notes that an estimated 1.27 million deaths globally were directly attributable to bacterial antimicrobial resistance in 2019, with millions of additional deaths where AMR was a contributing factor. Without effective interventions, projections suggest that drug-resistant infections could cause up to 10 million deaths annually by 2050, surpassing many leading causes of mortality globally.
Online medical consultations offer several benefits:
Increased access to care for remote or underserved populations
Reduced travel and waiting time for patients
Facilitation of follow-up care for chronic conditions
However, the risks of antibiotic overprescription, particularly when clinical assessments are expedited or incomplete are increasing.
India’s Telemedicine Practice Guidelines clearly permit remote consultations but emphasize that prescriptions must follow the same standards of clinical judgment, documentation, and patient evaluation as in-person care, especially for antibiotics and other regulated medicines. ¹ These principles align with established antimicrobial stewardship frameworks, which stress that antibiotics should be prescribed only when clearly indicated, at the right dose, for the right duration. ²
In addition to resistance, inappropriate antibiotic use can lead to:
Adverse drug reactions and side effects
Disruption of normal microbiota
Unnecessary healthcare costs
Masking of underlying conditions requiring further investigation
The proliferation of online medical consultation and prescription platforms presents both opportunities and challenges. While telemedicine can expand access to healthcare, observations such as those described by Dr. Vishal Gabale suggest that antibiotic prescribing practices in some digital environments may not consistently align with robust clinical assessment standards.
Public health experts say stronger oversight, clearer accountability, and adherence to national telemedicine guidelines will be critical to prevent inappropriate antibiotic use from worsening India’s antimicrobial resistance burden.
Ministry of Health and Family Welfare, Government of India. Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine. March 25, 2020. https://www.mohfw.gov.in/pdf/Telemedicine.pdf
World Health Organization. Antimicrobial Stewardship Programmes in Health-Care Facilities in Low- and Middle-Income Countries: A WHO Practical Toolkit. Geneva: WHO; 2019. https://www.who.int/publications/i/item/WHO-EMP-IAU-2019.11
