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There are several limitations to this study. 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. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. 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. 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. 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. Our study suggests that the opposite might be the case. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. No prescription was required, and no online consultation was necessary. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. 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. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.

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