Add crisis to cart: Why instant delivery and antibiotics don't mix

It starts the way it often does in Indian cities now: a work night before a big day, a meeting on the calendar, and an app on your phone’s home screen. A cough that has lingered for a week, the worry it might get worse, and the desire to be functional tomorrow. You open a quick‑commerce app that promises groceries in ten minutes and medicines in under an hour. A search bar, a suggestion chip for “cough & cold,” and then the thing you are not supposed to be able to buy without due process: an antibiotic.

You add it to the cart. The funnel is clean: pay now, and then choose between ‘upload prescription’ or ‘free teleconsult’. The order clock starts ticking only after payment. The clinical check is somewhere in the future.

This inversion—commerce first, medicine later—isn’t a glitch. It’s how some of India’s fastest‑growing platforms have decided to sell regulated drugs. And it lands in a country primed to say yes. For decades, the neighbourhood pharmacist has doubled as nurse, counsellor and sometimes, general physician. WhatsApp forwards pass for medical advice. Leftover tablets live in kitchen drawers. Antibiotics, especially, have become reflex—a strip for a cold, a child’s fever, “something viral.” We have learned to treat them like household tools. Apps now make that reflex kick in faster.

Also read: How drug-resistant tuberculosis is bringing life to a halt in India

Inside the apps

To see how quickly that reflex turns into a delivery at the door, I ran a simple test over three days in Bengaluru on six leading platforms: four quick‑commerce marketplaces that fulfill orders through partner pharmacies, and two inventory‑led e‑pharmacies that ship from their own licensed stores. I attempted to buy three common Schedule H antibiotics, including Augmentin. By law, these drugs require a doctor’s prescription and pharmacist oversight because inappropriate use can drive resistance, trigger serious side effects or lead to dependence. I also tried one Schedule H1 drug—Levoflox (levofloxacin)—which calls for stricter rules: pharmacies must record the buyer’s details, the prescriber’s name and the quantity sold, and preserve those records for three years.

This inversion—commerce first, medicine later—isn’t a glitch.

Each attempt succeeded. Most deliveries arrived within minutes; some in six, most under fifty. One took a day and a half, but the ordering experience was the same.

The architecture of the checkout explains why. The apps present a fork: upload a prescription or get a “free” teleconsult. In practice, both paths flip the sequence that any responsible pharmacist or physician would expect. The user must pay for the medication before any meaningful verification—be it a prescription check or a teleconsultation—is initiated. This design makes the medical justification a reversible afterthought, while the sale is a locked-in certainty.

When I uploaded prescriptions, some platforms accepted documents that were outdated, mismatched in dosage, or obviously not for the drug in the cart. By law, under the Drugs & Cosmetics Act and the Pharmacy Act—reinforced by a 2015 circular that extended these rules to online sales—every prescription is supposed to be reviewed by a pharmacist, the same as when you hand one over at a physical counter. But most approvals happened silently, and it remained unclear whether a pharmacist actually looked at my prescriptions. In one case only, a pharmacist did review my prescription, caught the discrepancy, called me to reject it, and then set up a teleconsult with a doctor who approved the order within minutes.

This design makes the medical justification a reversible afterthought, while the sale is a locked-in certainty.

The teleconsults themselves were brief. Audio calls, often under a minute, with three to four questions, sometimes leading. “Is your throat hurting?” when the order was for Azithromycin. “Any allergies?” “Name and age?” Vague complaints—“ear pain,” “ran out of medicines,” “my doctor gave this months ago”—were enough for both Schedule H and H1 drugs. The digital prescriptions produced after these calls were inconsistent: different diagnoses for identical symptoms, different dosage schedules for the same medicine, and patient names that didn’t match the account holder. All doctors were located in cities and small towns far away. The antibiotics shipped anyway.

On August 11, the All India Organisation of Chemists and Druggists (AIOCD), representing 1.24 million chemists nationwide, sounded the alarm for its own reasons and some of the public’s. They wrote to Union Home Minister Amit Shah, naming big quick‑commerce brands and accusing them of delivering Schedule H, H1 and X drugs within minutes while “skipping mandatory prescription verification”. The group flagged “ghost prescriptions”—medicines approved without genuine verification, including late-night approvals for distant patients—and warned that easy access to controlled substances could fuel drug abuse among the youth.

The business model 

These failures are embedded in three business models that are now vying for the pharmacy market.

Inventory-led companies sell from their own licensed pharmacies and manage inventory, emphasising—at least on paper—pharmacist-verified supply over speed. Marketplace e-pharmacies don’t hold their own retail licences. They connect customers to a network of licensed pharmacies that dispense the drugs. Finally, quick-commerce platforms plug into this system as logistics/tech intermediaries, often tying up with marketplace players or licensed pharmacies to deliver in minutes. 

Speed is loyalty and friction is the enemy. A pharmacist who calls back to ask a hard question becomes a drop‑off point in a funnel.

This distinction is not determinative for the safety of the consumer. All three models delivered antibiotics with equal ease and equal lack of meaningful checks. None of this is surprising if you’ve watched Indian e‑commerce and quick commerce over the last five years; the race is to become the app you open daily. Average order values for medicines are higher than those for groceries, with repeat rates often hitting 50% monthly, creating the sticky customer relationships that platforms desperately seek to make investors happy.

Speed is loyalty and friction is the enemy. A pharmacist who calls back to ask a hard question becomes a drop‑off point in a funnel.

The radius of harm

This would be just another story about tech breaking things if antibiotics were ordinary goods. They aren’t. Misusing antibiotics—taking them when not needed, stopping early, or taking the wrong one—kills off the easy-to-kill bacteria and strengthens the survivors, who multiply and share resistance traits.

The result shows up in labs: about 37% E. coli isolates (the most common bacterial pathogen) tested by the Indian Council of Medical Research no longer responded to imipenem, a class of medication doctors try to save for severe infections. Routine infections now drag on for longer, cost more, and force doctors to burn through classes of drugs they would rather hold back. As reliability fades, risks are mounting across the system since surgeries, chemotherapy, and intensive care all depend on antibiotics working.

What makes this risk sharper is the mix of drugs that online pharmacies keep in stock. The World Health Organisation classifies antibiotics into three groups: Access (broad-spectrum, lower resistance potential), Watch (higher resistance risk, should be restricted), and Reserve (last-resort drugs). Its stewardship goal is that at least 60% of global antibiotic use come from the Access group. But a study of Indian e-pharmacies found over 70% of the antibiotics available online fell in the Watch category, with Reserve drugs also on offer—widening the scope for misuse.

Of the four antibiotics I tested, three fall in WHO’s ‘Watch’ category, with only Augmentin in the safer ‘Access’ group.

Dr Sharad Khorwal, a general physician in Noida, has watched this change at the bedside. “Diseases we once handled with oral antibiotics now often need intravenous therapy, sometimes third‑ or fourth‑generation antibiotics. When I started my medical career forty years ago, typhoid was infrequent and responded to antibiotic pills. Today, most cases need 10–15 days of IV treatment. The tablets that worked then are just out of action.”

When I shared what medicines I was able to order via the apps, he’s blunt: “Azithromycin, Augmentin, Levofloxacin are very potent antibiotics. But today people are using Azithromycin like Vitamin C, not knowing that it’s one of the medicines required to treat drug-resistant typhoid. Look at the harm being done.”

Also read: The looming crisis of post-antibiotic era

A country primed for speed

The deeper problem is cultural muscle memory. For many families, time and money are tight. The clinic is far, but the pharmacist is near. For many, self‑medication is not a corner case; it’s a starting point. Instant delivery apps didn’t create that habit, but they are scaling it. 

And the state hasn’t kept up. The Drugs & Cosmetics Act, 1940, and its Rules, 1945, are the bedrock. They created Schedules H and H1, mandating a prescription for sale. The Pharmacy Act, 1948, regulates the profession. These laws were written for a world of physical counters and paper trails. But a 2015 circular by the Drugs Controller General of India did clearly state that all online and offline sellers must meet the same licence/pharmacist/prescription obligations. 

In 2018, the health ministry drafted e-pharmacy rules as an amendment to the Drugs and Cosmetics Rules, 1945, to address online sales, requiring central registration and mandating pharmacist verification. Seven years later, those rules have still not been notified. Besides, they failed to cover marketplace players, focussing only on e-pharmacies. In late 2022, the government introduced the Drugs, Medical Devices and Cosmetics Bill, a law intended to replace the 1940 Act. It explicitly brings e-pharmacies under its regulatory ambit by requiring mandatory licensing. This, too, remains in draft form.

This regulatory inertia has forced courts to intervene: the Delhi High Court has repeatedly directed the government to formulate rules, while the Madras High Court has clarified, in 2024, that existing pharmacy laws apply equally online, but has allowed online sales to continue pending final notification.

The newly enacted Digital Personal Data Protection (DPDP) Act, 2023 further complicates matters with few specific safeguards for health data, leaving prescription images and medical histories vulnerable on corporate servers. “When you come to my shop,” notes Rajiv Singal, General Secretary of AIOCD, “I don’t store your private health data. I don’t tell anyone what you have. Why should an app have a database that stores a record that you have tuberculosis or diabetes? That’s your secret, that’s your private matter.”

The 2020 Telemedicine Practice Guidelines updated during COVID-19 already provide a framework for remote consultations. They require a proper patient history and documentation, and video calls as the doctors deem necessary. But, as my testing showed, the perfunctory, sub-one-minute audio chats used to approve antibiotics on demand violate this spirit.

These regulatory gaps and delays have been good for the apps. They have enabled the surge of the marketplace model, particularly attractive to quick-commerce platforms backed by foreign direct investment (which faces restrictions in inventory-based pharmacy models). By acting as intermediaries rather than licensed dispensers, these platforms keep liability and capital needs lower, while scaling fast.

The way forward

Like many physicians, Dr Khorwal believes instant delivery of prescription medicines, especially antibiotics, is fundamentally incompatible with responsible use. “A 1:1 physical examination of the patient is compulsory.” When asked about the way forward if we assume digital access to medicines is here to stay, he stands his ground. “For OTC medicines and supplements, online delivery is okay. For the elderly, for the immobile, teleconsultation is also fine for the first line of treatment. But nothing can replace an in-person examination by a doctor.”

Younger doctors are more open to the need and inevitability of digital innovation, but also draw the line when it comes to the nature of 1:1 consultations. “Teleconsultations for prescription medicines need to be via a video call at the very least, otherwise it’s impossible to diagnose acute or chronic conditions that actually require antibiotics,” according to Dr Rahul Arora, a general physician based in Delhi.

Given the government’s unwavering focus on the National Digital Health Mission, it’s safe to assume online delivery of medicines is here to stay. And it undeniably solves real access problems. The goal then is to innovate towards safety, and the technical fixes aren't that hard to imagine.

For OTC medicines and supplements, online delivery is okay. For the elderly, for the immobile, teleconsultation is also fine for the first line of treatment. But nothing can replace an in-person examination by a doctor.

Two Bengaluru-based product managers (PMs) in quick commerce described how they would design this safeguard, if speed wasn’t the only factor.

• Antibiotic checkout could be hard-gated: payment blocked until a valid, verified, signed prescription is uploaded or issued after a teleconsult. Less like buying noodles, more like authenticating a bank transfer 
• If the cart mixes groceries and an antibiotic, the app could auto-split the order, sending the groceries right away and holding the antibiotic until approval. With cards, the charge could be delayed until approval; with UPI or cash, you’d pay for the groceries first and a new order is created for the antibiotic once cleared
• Automated name matching between prescription and account holder, with pharmacist callbacks when they don’t align
• Teleconsults could be standardised: compulsory video, structured questions, and clear display of the doctor’s name, qualifications, and registration number, logged with consult notes
• Within a single platform, prescriptions could be digitally hashed to prevent re-use and repeat orders could be slowed with cooldowns unless a fresh script is uploaded

These safeguards could be coded directly into checkout flows. But some problems like preventing the same prescription being reused across multiple platforms need regulation and enforcement. That is where product fixes end and the law must step in.

For instance, the UK requires online and distance-selling pharmacies to check the patient’s identity using photo IDs, facilitate robust two-way clinical exchanges between the patient and prescriber (particularly if antimicrobials are in play) and almost everyone uses the same central digital rail–the NHS Electronic Prescription Service. Prescribers (GPs and other authorised clinicians) and pharmacy teams sign in with smartcards. Each prescription is created, signed, dispensed and logged in one system, tied to named professionals. This combination of strict checks and shared infrastructure blocks anonymous approvals, makes re-use across outlets hard and gives regulators a clean audit trail.

A good place to start for India, as Kazim Rizvi–founder of The Dialogue, a Delhi-based think tank at the intersection of tech, public policy and society–writes, is finalising the 2018 e-pharmacy rules and explicitly covering marketplace/intermediary platforms. And then, operationalising them: make apps verify every seller by having pharmacies upload their licence to their backend; mandate audit trails linking each order, prescription, verifying pharmacist and dispensing pharmacy; and, require platforms to retain those trails and teleconsult notes for audits.

But some problems like preventing the same prescription being reused across multiple platforms need regulation and enforcement. That is where product fixes end and the law must step in.

Finally, ensure every order is billed by the licensed pharmacy (not the app) with a traceable cash/credit memo listing the patient, drug/strength, quantity, prescriber and Rx date, pharmacist registration, timestamp, order ID, and the pharmacy’s licence number.

The nuance here is that none of this kills speed for most orders. The number of people who order antibiotics on any given day is a tiny slice of the total volume. Platforms can dial up safeguards only for those products and only at the point of risk. Delivery times might increase by a few minutes or hours for antibiotic orders, but that seems like a fair trade for public health.

Also read: Meet the minds investigating bugs lurking in poultry

The doorbell

The bell rings. The last order in my three-day test arrives. A paper bag with a strip of tablets inside, no invoice, no prescription. 

I don’t take the pills. The strip sits unopened because this was a test of the pathway, not a cure. But the ease with which I could have taken them—the way the apps made it feel normal—is the point.

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