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As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. Fifth, we estimated the expected delivery time to take antibiotics. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. This activity suggests that some vendors are aware of the questionable legitimacy of their business. There are several limitations to this study. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. All these obstacles cause the illegal acquisition of antibiotics by patients. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.

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