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The links to these advertised sites were also investigated. The frequency of relevant Web sites declined substantially after the first 300. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. 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). 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. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. As part of this study, we bought over-the-counter antibiotics over the counter. Third, we categorized the classes of antibiotics available for purchase. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. All these obstacles cause the illegal acquisition of antibiotics by patients.

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