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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 extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. 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. 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. Fourth, we have limited our count to English language websites. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. We classified Web sites of vendors according to several variables. Although the vast majority of websites were in English, some were in other languages. 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. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error.

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