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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. Fifth, we estimated the expected delivery time to take antibiotics. Patients are increasingly using the Internet not only to access health information but also to obtain medication. 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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. Our final list of URLs included 184 links to single vendors of antibiotics. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. All these obstacles cause the illegal acquisition of antibiotics by patients.

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