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There are several limitations to this study. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. Although the vast majority of websites were in English, some were in other languages. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. 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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.

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