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We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. No prescription was required, and no online consultation was necessary. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Third, we categorized the classes of antibiotics available for purchase. 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. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. Our study suggests that the opposite might be the case.

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