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Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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. 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. 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. 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. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. 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. All these obstacles cause the illegal acquisition of antibiotics by patients. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics.

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