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In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. 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 Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Fourth, we have limited our count to English language websites. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. There are several limitations to this study. No prescription was required, and no online consultation was necessary. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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.

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