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Fourth, we have limited our count to English language websites. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Our study suggests that the opposite might be the case. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. The vendors identified in this study do not appear to be fearful of prosecution. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. 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. 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. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. 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. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives.

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