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Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The vendors identified in this study do not appear to be fearful of prosecution. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Fourth, we have limited our count to English language websites. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. 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. 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. 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. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription.

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