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European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. All these obstacles cause the illegal acquisition of antibiotics by patients. Thus, vendors targeting foreign-language speakers in the United States would have been missed. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Fourth, we have limited our count to English language websites. As part of this study, we bought over-the-counter antibiotics over the counter. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Our final list of URLs included 184 links to single vendors of antibiotics. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. 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. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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.

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