Washington, DC-The run on Cipro following October's anthrax scare was a bonanza for pharmacy websites, but it stirred the wrath of both FDA and the medical establishment. In response to escalating ciprofloxacin promotion over the internet, FDA sent cyber letters to 11 websites for offering US consumers products that may not be approved for sale in the United States, warning that US Customs might detain shipments. The agency also took more stringent action against five previously warned foreign vendors.

Pharmacists also were quick to alert the public to the risk of purchasing antibiotics online, because the products could be counterfeit, contaminated, expired, or ineffective. Pharmacists generally oppose internet and mail-order sales of medicines, especially from overseas vendors.

And those operators' assertions that they will fill a prescription only after an online "consultation" with a doctor have antagonized the medical community. The North Carolina Medical Board brought charges against a physician for writing Cipro prescriptions with only a "virtual" check-up, performed through VirtualMedicalGroup, which is linked to the state's MedicalWeb.com. Although the North Carolina medical board stated that online prescribing is unprofessional and "inappropriate," it is not illegal in most states. VirtualMedicalGroup says it obtains Cipro from a US wholesaler, which may keep it out of trouble with FDA.