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Third, we categorized the classes of antibiotics available for purchase. 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. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. 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. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. The vendors identified in this study do not appear to be fearful of prosecution. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. 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. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Our final list of URLs included 184 links to single vendors of antibiotics. Our study suggests that the opposite might be the case. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site.

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