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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. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. Our study suggests that the opposite might be the case. 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. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. 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. We classified Web sites of vendors according to several variables. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. 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. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms.

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