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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. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Our study suggests that the opposite might be the case. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Third, we categorized the classes of antibiotics available for purchase. 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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. 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.

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