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This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. Although the vast majority of websites were in English, some were in other languages. 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). Fourth, we have limited our count to English language websites. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade.

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