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Fifth, we estimated the expected delivery time to take antibiotics. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. We classified Web sites of vendors according to several variables. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. No prescription was required, and no online consultation was necessary. The vendors identified in this study do not appear to be fearful of prosecution. 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. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts.

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