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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. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. The links to these advertised sites were also investigated. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Fourth, we have limited our count to English language websites. The frequency of relevant Web sites declined substantially after the first 300. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. No prescription was required, and no online consultation was necessary. 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. 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. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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 our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each.

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