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In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. Fourth, we have limited our count to English language websites. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. The vendors identified in this study do not appear to be fearful of prosecution. We classified Web sites of vendors according to several variables. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. All these obstacles cause the illegal acquisition of antibiotics by patients. This phenomenon has not been the focus of initiatives to control antibiotic resistance. 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. 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. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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. Our purchase arrived from Mexico with no information on instructions for use of the medication. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use.

Lake Boren Christian School