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Our study suggests that the opposite might be the case. Fourth, we have limited our count to English language websites. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. The links to these advertised sites were also investigated. There are several limitations to this study. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. All these obstacles cause the illegal acquisition of antibiotics by patients. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated.

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