AI-Generated Summary:
Amazon plans to roll out prescription drug vending machines (kiosks) that will dispense antibiotics among other medications, aiming to increase access and convenience. However, the removal of in-person pharmacist and community pharmacy engagement raises concerns about appropriate antibiotic use, potential overprescribing, leftover drugs, and erosion of antimicrobial stewardship principles.
Authored by: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Developed with the support of ChaGPT
Article Posted 12 October 2025
Last week Amazon announced it would be placing prescription drug vending machines (also referred to as kiosks) into communities, including within Los Angeles area One Medical locations in December 2025, with plans for a more broader rollout in 2026.
The prescription drug vending machines are reportedly going to carry hundreds of common medications, including antibiotics. Inventories are going to be tailored to the prescribing patterns for each location. Patients will be able to create an Amazon Pharmacy account, have an appointment at a One Medical location, and then pay for the medication in the Amazon app.
While the concept promises faster, more convenient access to medications, it also removes the pharmacist from the physical dispensing process. Pharmacists will still be available for virtual consultations, but the absence of in-person interaction raises questions about patient safety, appropriate antibiotic use, and stewardship practices.
Given the substantial impact prescription drug vending machines with antibiotics can have on what is put into the community, it begs to question – is this a good or bad thing for antibiotic stewardship? To foster consideration of this question, here are some questions and commentary surrounding this initiative.
1. Who will oversee the inventory management?
Will inventory decisions be purely data-driven—based on prescribing frequency, dose, and strength—or will there be clinical oversight from pharmacists or medical leadership? How often will these inventories be reviewed or adjusted? It seems likely inventories will not be edited much once launched.
Looking at the photo on the Amazon website, the size of the machine does not appear to be able to store hundreds of medications. Will the medications that are selected be more focused on common chronic conditions or will there be many items to address acute processes too? Antibiotics such as azithromycin, amoxicillin-clavulanic acid, cephalexin, sulfamethoxazole-trimethoprim, doxycycline, cefdinir, nitrofurantoin are all likely candidates for the machines. Perhaps symptomatic therapy management therapeutics will also be offered.
2. Which antibiotic quantities will be offered?
Since prescription drug vending machines cannot offer every possible duration of therapy and dose, how will that impact what a patient ultimately receives? Will the kiosks end up with 20 days of ciprofloxacin 500 mg BID (so 40 count) and then if someone is prescribed to have it for 3 days they will end up with 17 extra days (34 extra tabs) of ciprofloxacin?
Excess antibiotics often end up saved for future use or shared with others, both of which undermine stewardship efforts. While patients may be advised to dispose of unused medication, proper disposal is rarely followed in practice. Without careful configuration, these machines could amplify antibiotic misuse.
There are some prescription drug vending machines in urgent care centers I have seen that offer multiple quantities of the same antibiotic to help reduce excessive durations going to patients (e.g. a ciprofloxacin 3-day or 10-day option). In some countries outside the United States (e.g., Spain) many antibiotics come from community pharmacies as a static count (i.e., a 10-day amoxicillin pack is dispensed regardless of what duration up to 10 days is prescribed).
Amazon could consider customizing antibiotic quantities in their kiosks to help promote stewardship principles.
3. How will prescribing behavior change?
The presence of nearby vending machines could alter provider behavior—for better or worse. Ideally, they could encourage evidence-based prescribing through curated inventories. But if inventory is driven by current local prescribing patterns, it may simply reinforce existing poor practices.
For example, rapid access to oseltamivir could be beneficial for influenza cases, yet delayed prescribing strategies—important for antibiotic stewardship—might be undermined if patients can instantly obtain antibiotics “just in case.”
Drawing from my own experience redesigning urgent-care kiosks (presented at IDWeek 2023), modest changes such as limiting antibiotic duration options contributed to significant reductions in fluoroquinolone use. Amazon could achieve similar results with thoughtful design and oversight.
4. Will patient expectations increase?
Providers often face patient pressure for antibiotics, especially when patients equate prescriptions with good care. The physical proximity of an antibiotic-dispensing machine could intensify that pressure.
Shared decision-making remains key to promoting rational antibiotic use. But will these conversations become harder when antibiotics are just steps away? If so, clinicians may face greater challenges balancing patient satisfaction with clinical appropriateness.
5. What happens without in-person pharmacist engagement?
Pharmacists play an essential role in counseling, monitoring interactions, and ensuring adherence, especially for short-term antibiotic therapies. A virtual-only pharmacist model could diminish that support.
If Amazon succeeds in facilitating meaningful pharmacist-patient engagement through digital channels, this concern could be mitigated. Otherwise, reduced access to pharmacists may lead to lower medication safety and adherence.
Closing Comments
As Amazon’s prescription drug vending machines roll out, they represent both an innovation in healthcare access and a challenge to traditional medication safety frameworks. These kiosks could improve convenience and efficiency, but without careful oversight, they risk eroding key safeguards in antibiotic stewardship.
The path forward should focus on leveraging this technology to enhance rational prescribing, optimize antibiotic use, and preserve the pharmacist’s role—even if that role evolves into a more virtual form.
References & Resources
- Amazon Pharmacy introduces in-office kiosks to help patients get medications immediately after appointments
- Amazon to start offering prescription drugs through vending machines
- 2954. Coordinated Antimicrobial Stewardship Efforts to Produce Sustained Reductions in Outpatient Fluoroquinolone Consumption. OFID. 2023.
- Delayed antibiotic prescriptions for respiratory infections. Chochrane Database. 2017.
- EVALUATING ABANDONMENT OF URGENT CARE PRESCRIPTIONS SENT TO AN AUTOMATED DRUG DISPENSER VS A COMMUNITY PHARMACY: A RETROSPECTIVE COHORT STUDY
- Improving outpatient primary medication adherence with physician guided, automated dispensing
- Shorter Is Better – Brad Spellberg
Disclosures
The opinions and perspectives in this article represent those of the author and do not necessarily reflect the position or policy of any past, present, or potential future employer.
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