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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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. We classified Web sites of vendors according to several variables. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. As part of this study, we bought over-the-counter antibiotics over the counter. Fourth, we have limited our count to English language websites. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. 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. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. The vendors identified in this study do not appear to be fearful of prosecution.

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