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Although the vast majority of websites were in English, some were in other languages. Fifth, we estimated the expected delivery time to take antibiotics. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. The links to these advertised sites were also investigated. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. We classified Web sites of vendors according to several variables. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. 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.

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