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Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Patients are increasingly using the Internet not only to access health information but also to obtain medication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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. 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. Our study suggests that the opposite might be the case. The frequency of relevant Web sites declined substantially after the first 300. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. 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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care.

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