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Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. The frequency of relevant Web sites declined substantially after the first 300. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. 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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. 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 compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. This activity suggests that some vendors are aware of the questionable legitimacy of their business. 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. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts.

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