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Fourth, we limited our count to English language Web sites.

International Drugstore

Although the great majority of Web sites were in English, some were in other languages. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Finally, and potentially the biggest limitation to the importance of this study, is that we were unable to describe how much this Internet-based purchasing strategy was used for acquiring antibiotics by individuals in the United States. 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.

In conclusion, antibiotics are freely available for purchase on the Internet without a prescription, and the general structure of the transactions encourages self-medication and low quality of care. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Additional education directed to patients and the community, as well as increased regulation and enforcement of existing regulations, may help in controlling this potentially vast reservoir of antibiotics.

Conflicts of interest: none reported. National Center for Biotechnology Information , U. Journal List Ann Fam Med v. Ann Fam Med. Arch G. Everett , PhD, Robert E.

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Post , MD, Vanessa A. Hueston , MD. Mainous, III. Charles J. Robert E. Vanessa A. William J. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Keywords: Health care delivery, quality of health care, infectious disease, antibiotics, drug resistance, bacterial. Table 1.

Additional information

Open in a separate window. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. Washington, DC: Institute of Medicine; Infectious Diseases Society of America. Sarkar P, Gould IM. Antimicrobial agents are societal drugs: how should this influence prescribing? Neu HC. The crisis in antibiotic resistance.

Availability of Antibiotics for Purchase Without a Prescription on the Internet

Cohen ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial.

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An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. Availability of injectable antibiotics in a town market in southwest Cameroon. Lancet Infect Dis. Antimicrobial resistance in Streptococcus pneumoniae, Taiwan. Emerg Infect Dis. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country.

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