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We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. 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. 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. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. Thus, vendors targeting foreign-language speakers in the United States would have been missed. As part of this study, we bought over-the-counter antibiotics over the counter. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication.

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