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Third, we categorized the classes of antibiotics available for purchase. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. 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. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. All these obstacles cause the illegal acquisition of antibiotics by patients. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. Although the vast majority of websites were in English, some were in other languages. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription.