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Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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 phenomenon has not been the focus of initiatives to control antibiotic resistance. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. 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. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go.

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