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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. The vendors identified in this study do not appear to be fearful of prosecution. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. 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. 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. We classified Web sites of vendors according to several variables. 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. 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. 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. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go.