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This decrease was interpreted as evidence that the full use of antibiotics was also reduced. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. All these obstacles cause the illegal acquisition of antibiotics by patients. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. The frequency of relevant Web sites declined substantially after the first 300. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). 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. Fourth, we have limited our count to English language websites. 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. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment.

St Philip Neri Elementary School