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Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Thus, vendors targeting foreign-language speakers in the United States would have been missed. The links to these advertised sites were also investigated. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. All these obstacles cause the illegal acquisition of antibiotics by patients. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Third, we categorized the classes of antibiotics available for purchase. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. Fifth, we estimated the expected delivery time to take antibiotics. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies.

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