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In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. No prescription was required, and no online consultation was necessary. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. 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. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. As part of this study, we bought over-the-counter antibiotics over the counter. 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. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance.