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Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Third, we categorized the classes of antibiotics available for purchase. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. Fourth, we have limited our count to English language websites. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. This activity suggests that some vendors are aware of the questionable legitimacy of their business.