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Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. The frequency of relevant Web sites declined substantially after the first 300. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents.

Emmanuel Seventh Day Adventist Jr Academy