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We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. 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. 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. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. There are several limitations to this study. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. 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. 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). 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. Although the vast majority of websites were in English, some were in other languages.

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