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Thus, vendors targeting foreign-language speakers in the United States would have been missed. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. 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. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. 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. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. All these obstacles cause the illegal acquisition of antibiotics by patients. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections.

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