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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. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. 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. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. Fourth, we have limited our count to English language websites. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Thus, vendors targeting foreign-language speakers in the United States would have been missed. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. This phenomenon has not been the focus of initiatives to control antibiotic resistance. 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.

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