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Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. There are several limitations to this study. The links to these advertised sites were also investigated. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. 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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. 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.

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