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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. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The frequency of relevant Web sites declined substantially after the first 300. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. 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. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. 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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. 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). Third, we categorized the classes of antibiotics available for purchase. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication.

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