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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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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. There are several limitations to this study. All these obstacles cause the illegal acquisition of antibiotics by patients. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. 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. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior.

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