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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Third, we categorized the classes of antibiotics available for purchase. Our study suggests that the opposite might be the case. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. 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. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. 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.

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