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The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. We classified Web sites of vendors according to several variables. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. Although the vast majority of websites were in English, some were in other languages. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. All these obstacles cause the illegal acquisition of antibiotics by patients.

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