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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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. The vendors identified in this study do not appear to be fearful of prosecution. 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. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Our final list of URLs included 184 links to single vendors of antibiotics. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Third, we categorized the classes of antibiotics available for purchase. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. 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. All these obstacles cause the illegal acquisition of antibiotics by patients. Fourth, we have limited our count to English language websites. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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.

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