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We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. No prescription was required, and no online consultation was necessary. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. 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. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. 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. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations.

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