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The frequency of relevant Web sites declined substantially after the first 300. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. This activity suggests that some vendors are aware of the questionable legitimacy of their business. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. Our study suggests that the opposite might be the case. Although the vast majority of websites were in English, some were in other languages. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Our purchase arrived from Mexico with no information on instructions for use of the medication. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. 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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