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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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 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. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Patients are increasingly using the Internet not only to access health information but also to obtain medication. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients.

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