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Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. 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). The vendors identified in this study do not appear to be fearful of prosecution. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. As part of this study, we bought over-the-counter antibiotics over the counter. 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. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics.

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