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No prescription was required, and no online consultation was necessary. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. 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). Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Patients are increasingly using the Internet not only to access health information but also to obtain medication. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Third, we categorized the classes of antibiotics available for purchase. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance.

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