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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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages. 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. The links to these advertised sites were also investigated. Although more than half of the identified sites provided online consultation for prescribing, the lack of interaction between the patient and the doctor did not lead to any opportunity for patient education. This phenomenon has not been the focus of initiatives to control antibiotic resistance. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. The frequency of relevant Web sites declined substantially after the first 300. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. The vendors identified in this study do not appear to be fearful of prosecution. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. Although the vast majority of websites were in English, some were in other languages.