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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The vendors identified in this study do not appear to be fearful of prosecution. 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. There are several limitations to this study. The frequency of relevant Web sites declined substantially after the first 300. 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. Our study suggests that the opposite might be the case. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. 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 our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication.

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