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Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. This activity suggests that some vendors are aware of the questionable legitimacy of their business. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. 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. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Patients are increasingly using the Internet not only to access health information but also to obtain medication. 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. 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. The frequency of relevant Web sites declined substantially after the first 300. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Our study suggests that the opposite might be the case.

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