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Our study suggests that the opposite might be the case. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. 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. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. The vendors identified in this study do not appear to be fearful of prosecution.

Primrose School at Palm Valley
St John Vianney Catholic School