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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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. 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. The vendors identified in this study do not appear to be fearful of prosecution. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. No prescription was required, and no online consultation was necessary. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. 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. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated.

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