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Patients are increasingly using the Internet not only to access health information but also to obtain medication. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. 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. 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. The vendors identified in this study do not appear to be fearful of prosecution. 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. 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. Fifth, we estimated the expected delivery time to take antibiotics. 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. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents.

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