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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. 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. 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. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. All these obstacles cause the illegal acquisition of antibiotics by patients. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Fifth, we estimated the expected delivery time to take antibiotics. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Third, we categorized the classes of antibiotics available for purchase.

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