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For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. Our final list of URLs included 184 links to single vendors of antibiotics. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. The frequency of relevant Web sites declined substantially after the first 300. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with 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. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use.

Red Hill Christian School