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The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. 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. 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 frequency of relevant Web sites declined substantially after the first 300. Fourth, we have limited our count to English language websites. 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. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. This activity suggests that some vendors are aware of the questionable legitimacy of their business. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. 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. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. Third, we categorized the classes of antibiotics available for purchase. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.

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