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Fifth, we estimated the expected delivery time to take antibiotics. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. 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. We classified Web sites of vendors according to several variables. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with 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. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. The vendors identified in this study do not appear to be fearful of prosecution. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. No prescription was required, and no online consultation was necessary. 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.

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