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Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Fourth, we have limited our count to English language websites. The frequency of relevant Web sites declined substantially after the first 300. The vendors identified in this study do not appear to be fearful of prosecution. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. Our study suggests that the opposite might be the case. Patients are increasingly using the Internet not only to access health information but also to obtain medication. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting.

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