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The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Patients are increasingly using the Internet not only to access health information but also to obtain medication. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections.

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