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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. 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. The links to these advertised sites were also investigated. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. 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. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. 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. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Our study suggests that the opposite might be the case. No prescription was required, and no online consultation was necessary. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies.