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First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. 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. Fifth, we estimated the expected delivery time to take antibiotics. No prescription was required, and no online consultation was necessary. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. 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. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The links to these advertised sites were also investigated. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents.

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