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Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. The vendors identified in this study do not appear to be fearful of prosecution. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. 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. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics.

Immanuel Missionary School