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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. No prescription was required, and no online consultation was necessary. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Our study suggests that the opposite might be the case. 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. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. 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. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. 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. 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. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. The links to these advertised sites were also investigated.

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