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Fourth, we have limited our count to English language websites. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. This phenomenon has not been the focus of initiatives to control antibiotic resistance. As part of this study, we bought over-the-counter antibiotics over the counter. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. There are several limitations to this study. 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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Although the vast majority of websites were in English, some were in other languages. Fifth, we estimated the expected delivery time to take antibiotics.

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