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Often it only gets worse. Buy Indian Amoxicillin Online sign anything, or use an illegible ultra-simple scrawl for a signature. Saint paul. 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. Moreover, we discovered that some URLs were attached to servers at educational institutions, apparently without their knowledge or consent. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication.

Even with these strategies, however, it was difficult to know whether one corporation still owns and controls multiple sites. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Fourth, we limited our count to English language Web sites. Although the great majority of Web sites were in English, some were in other languages. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Finally, and potentially the biggest limitation to the importance of this study, is that we were unable to describe how much this Internet-based purchasing strategy was used for acquiring antibiotics by individuals in the United States. Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance.

In conclusion, antibiotics are freely available for purchase on the Internet without a prescription, and the general structure of the transactions encourages self-medication and low quality of care. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Additional education directed to patients and the community, as well as increased regulation and enforcement of existing regulations, may help in controlling this potentially vast reservoir of antibiotics. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. Washington, DC: Institute of Medicine; 2003. Infectious Diseases Society of America. Sarkar P, Gould IM. Antimicrobial agents are societal drugs: how should this influence prescribing?

Neu HC. The crisis in antibiotic resistance. Cohen ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. Availability of injectable antibiotics in a town market in southwest Cameroon. Lancet Infect Dis. Antimicrobial resistance in Streptococcus pneumoniae, Taiwan. Emerg Infect Dis. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Soc Sci Med.

Calva J, Bojalil R. Antibiotic use in a periurban community in Mexico: a household and drugstore survey. Drug Utilization Research Group. Latin America. Multicenter study on self-medication and self-prescription in six Latin American countries.

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There are several limitations to this study. First, this study represents a sample of Web sites and vendors and thus may not be indicative of all of the vendors selling antibiotics without a prescription. 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. Moreover, we discovered that some URLs were attached to servers at educational institutions, apparently without their knowledge or consent. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication.

Even with these strategies, however, it was difficult to know whether one corporation still owns and controls multiple sites. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Fourth, we limited our count to English language Web sites. Although the great majority of Web sites were in English, some were in other languages. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Finally, and potentially the biggest limitation to the importance of this study, is that we were unable to describe how much this Internet-based purchasing strategy was used for acquiring antibiotics by individuals in the United States. Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance.

In conclusion, antibiotics are freely available for purchase on the Internet without a prescription, and the general structure of the transactions encourages self-medication and low quality of care. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Additional education directed to patients and the community, as well as increased regulation and enforcement of existing regulations, may help in controlling this potentially vast reservoir of antibiotics. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. Washington, DC: Institute of Medicine; 2003. Infectious Diseases Society of America. Sarkar P, Gould IM. Antimicrobial agents are societal drugs: how should this influence prescribing?

Neu HC. The crisis in antibiotic resistance. Cohen ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. Availability of injectable antibiotics in a town market in southwest Cameroon. Lancet Infect Dis. Antimicrobial resistance in Streptococcus pneumoniae, Taiwan. Emerg Infect Dis. The use of antimicrobial drugs in Nagpur, India.

A window on medical care in a developing country. Soc Sci Med. Calva J, Bojalil R. Antibiotic use in a periurban community in Mexico: a household and drugstore survey. Drug Utilization Research Group. Is the pharmacy licensed in the state in which it is located? If it is not licensed there, or if you can't find its location, then it may be offshore, located in another country. It's not enough to have a toll-free number, you need to be able to speak to a pharmacist. The key is confirming there is a bona fide pharmacist on staff. Foreign Pharmacies It's illegal for Americans to order drugs from any pharmacy located outside the United States, including Canada or Mexico. This is a law imposed by the U. In some circumstances, that law may be overlooked and not enforced. The FDA rules for purchasing from foreign pharmacies specifies a drug may be exported into the United States if all three of the following conditions are met: The drug is not yet approved in the United States but is prescribed for a serious condition for which there is no equivalent at home.

The amount imported is no more than a three-month supply.

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