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Thus, vendors targeting foreign-language speakers in the United States would have been missed. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. 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. We classified Web sites of vendors according to several variables. Fifth, we estimated the expected delivery time to take antibiotics. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. 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.