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Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. 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 Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated.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 extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. The vendors identified in this study do not appear to be fearful of prosecution. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians.

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