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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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Our final list of URLs included 184 links to single vendors of antibiotics. All these obstacles cause the illegal acquisition of antibiotics by patients. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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 extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Although the vast majority of websites were in English, some were in other languages. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws.

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