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In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. Patients are increasingly using the Internet not only to access health information but also to obtain medication. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Our final list of URLs included 184 links to single vendors of antibiotics. The links to these advertised sites were also investigated. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. We classified Web sites of vendors according to several variables. 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). This phenomenon has not been the focus of initiatives to control antibiotic resistance. 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. Our study suggests that the opposite might be the case. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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.

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