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Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. The frequency of relevant Web sites declined substantially after the first 300. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. All these obstacles cause the illegal acquisition of antibiotics by patients. 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. Fourth, we have limited our count to English language websites. 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. 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. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Fifth, we estimated the expected delivery time to take antibiotics. 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.

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