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Fourth, we have limited our count to English language websites. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. No prescription was required, and no online consultation was necessary. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. 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. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. This phenomenon has not been the focus of initiatives to control antibiotic resistance. We classified Web sites of vendors according to several variables. Although the vast majority of websites were in English, some were in other languages. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each.

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