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Patients are increasingly using the Internet not only to access health information but also to obtain medication. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. This activity suggests that some vendors are aware of the questionable legitimacy of their business. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. 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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. Although the vast majority of websites were in English, some were in other languages. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Fourth, we have limited our count to English language websites.

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