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This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. The vendors identified in this study do not appear to be fearful of prosecution. Fourth, we have limited our count to English language websites. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. There are several limitations to this study. The links to these advertised sites were also investigated. Our final list of URLs included 184 links to single vendors of antibiotics. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. The frequency of relevant Web sites declined substantially after the first 300. 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.

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