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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. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Finally, in order to determine whether these sites actually provide a product that they intended to sell over the counter, we submitted an online order to 1 vendor for 6 tablets of azithromycin, 500 mg each. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. Our final list of URLs included 184 links to single vendors of antibiotics. 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. Our study suggests that the opposite might be the case. All these obstacles cause the illegal acquisition of antibiotics by patients. Although the vast majority of websites were in English, some were in other languages.

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