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The frequency of relevant Web sites declined substantially after the first 300. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. 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. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. 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). This activity suggests that some vendors are aware of the questionable legitimacy of their business.

J. Howard Knox Child Development