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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. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Fifth, we estimated the expected delivery time to take antibiotics. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. The vendors identified in this study do not appear to be fearful of prosecution. All these obstacles cause the illegal acquisition of antibiotics by patients. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Our final list of URLs included 184 links to single vendors of antibiotics.

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