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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. 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. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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 frequency of relevant Web sites declined substantially after the first 300. The links to these advertised sites were also investigated. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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. Although the vast majority of websites were in English, some were in other languages. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Patients are increasingly using the Internet not only to access health information but also to obtain medication.

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