As I was wrapping up fieldwork in Guatemala in late 2021, I encountered and saved an advertisement circulating on Instagram (Figure 1). It displayed a series of images of medications beginning with a box of azithromycin, a broad-spectrum antibiotic used to treat various bacterial infections. The ad was sponsored by Paiz, a Mexican and Central American subsidiary of Walmart, which took advantage of the Instagram Shopping feature: a big red “shop now” button that takes viewers to sites where they can purchase the advertised products. In this post, the price was 15 Guatemalan quetzals (approximately 2 USD) for 30 500-mg tablets of azithromycin. The accompanying caption proclaimed, “Contamos con más surtido para que en tu alacena siempre tengás lo que te gusta” (We offer a greater selection so that you can always have whatever you like in your cupboard). A white label with a red sticker adorned the box. Its small lettering only became legible upon zooming in, reading, “ESTE PRODUCTO SE VENDE SOLO CON RECETA MÉDICA” (This product is sold only with a medical prescription.) Despite the antibiotic’s advertised availability, this fine print reflected recent efforts to limit its unrestricted sale in Guatemala. As part of a strategy for combatting rising rates of antibiotic resistance, the Guatemalan Ministry of Public Health and Social Assistance (MSPAS) issued a decree (acuerdo ministerial 145–2019) in June 2019 prohibiting nonprescription sales of antibiotic medications. This was also part of a broader effort among global health institutions and national governments to develop strategic action plans to address antibiotic resistance (Patel et al., 2023).

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