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Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Our purchase arrived from Mexico with no information on instructions for use of the medication. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. 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. Our final list of URLs included 184 links to single vendors of antibiotics. Fourth, we have limited our count to English language websites. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The links to these advertised sites were also investigated. 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. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients.

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