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The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. This phenomenon has not been the focus of initiatives to control antibiotic resistance. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem.

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