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There are several limitations to this study. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Although the vast majority of websites were in English, some were in other languages. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. The links to these advertised sites were also investigated. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future.

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