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No prescription was required, and no online consultation was necessary. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. The links to these advertised sites were also investigated. Fifth, we estimated the expected delivery time to take antibiotics. 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 websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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. 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. 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.

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