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After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. 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. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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.

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