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Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Our study suggests that the opposite might be the case. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Fourth, we have limited our count to English language websites. All these obstacles cause the illegal acquisition of antibiotics by patients. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Our final list of URLs included 184 links to single vendors of antibiotics. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. 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.

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