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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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. The vendors identified in this study do not appear to be fearful of prosecution. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. 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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. 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. 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.

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