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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. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. Fourth, we have limited our count to English language websites. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). As part of this study, we bought over-the-counter antibiotics over the counter. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. The vendors identified in this study do not appear to be fearful of prosecution. No prescription was required, and no online consultation was necessary.

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