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Although the vast majority of websites were in English, some were in other languages. 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. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. The links to these advertised sites were also investigated. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. 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). Fifth, we estimated the expected delivery time to take antibiotics. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. 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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Third, we categorized the classes of antibiotics available for purchase. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet.

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