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The links to these advertised sites were also investigated. Patients are increasingly using the Internet not only to access health information but also to obtain medication. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. Although the vast majority of websites were in English, some were in other languages. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. We classified Web sites of vendors according to several variables. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary.

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