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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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Fifth, we estimated the expected delivery time to take antibiotics. 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. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Our final list of URLs included 184 links to single vendors of antibiotics. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. Fourth, we have limited our count to English language websites. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. 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. Our study suggests that the opposite might be the case.

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