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Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Our purchase arrived from Mexico with no information on instructions for use of the medication. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. 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. 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. 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). Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. No prescription was required, and no online consultation was necessary. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem.

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