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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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. There are several limitations to this study. As part of this study, we bought over-the-counter antibiotics over the counter. Our final list of URLs included 184 links to single vendors of antibiotics. All these obstacles cause the illegal acquisition of antibiotics by patients. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future.