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Fourth, we have limited our count to English language websites. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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. 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. 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. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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. We classified Web sites of vendors according to several variables. 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. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business.

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