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Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. The links to these advertised sites were also investigated. Patients are increasingly using the Internet not only to access health information but also to obtain medication. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. There are several limitations to this study. 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. No prescription was required, and no online consultation was necessary.