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No prescription was required, and no online consultation was necessary. 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. 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. 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. Fourth, we have limited our count to English language websites. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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. There are several limitations to this study. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms.