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Our study suggests that the opposite might be the case. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. The frequency of relevant Web sites declined substantially after the first 300. There are several limitations to this study. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. As part of this study, we bought over-the-counter antibiotics over the counter. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. Fourth, we have limited our count to English language websites. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Third, we categorized the classes of antibiotics available for purchase. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts.

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