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Fifth, we estimated the expected delivery time to take antibiotics. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Third, we categorized the classes of antibiotics available for purchase. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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. 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. 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. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. 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.

Bethany Christian School