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For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. 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. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. 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. The vendors identified in this study do not appear to be fearful of prosecution. 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. No prescription was required, and no online consultation was necessary. Our final list of URLs included 184 links to single vendors of antibiotics. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Although the vast majority of websites were in English, some were in other languages. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment.

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