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After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Although the vast majority of websites were in English, some were in other languages. The vendors identified in this study do not appear to be fearful of prosecution. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Third, we categorized the classes of antibiotics available for purchase. 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. 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.

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