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Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. The vendors identified in this study do not appear to be fearful of prosecution. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary.

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