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The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. 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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The links to these advertised sites were also investigated. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. 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.

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