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Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Fifth, we estimated the expected delivery time to take antibiotics. The vendors identified in this study do not appear to be fearful of prosecution. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Our study suggests that the opposite might be the case. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. 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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Our final list of URLs included 184 links to single vendors of antibiotics. No prescription was required, and no online consultation was necessary.

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