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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. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. 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. 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. Although the vast majority of websites were in English, some were in other languages. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription.