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The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Fifth, we estimated the expected delivery time to take antibiotics. Our study suggests that the opposite might be the case. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. No prescription was required, and no online consultation was necessary. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. The frequency of relevant Web sites declined substantially after the first 300. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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.

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