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Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The vendors identified in this study do not appear to be fearful of prosecution. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.

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