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Fifth, we estimated the expected delivery time to take antibiotics. 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. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. The vendors identified in this study do not appear to be fearful of prosecution. All these obstacles cause the illegal acquisition of antibiotics by patients. Our final list of URLs included 184 links to single vendors of antibiotics. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. As part of this study, we bought over-the-counter antibiotics over the counter. 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. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication.

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