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We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. Our final list of URLs included 184 links to single vendors of 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. Our study suggests that the opposite might be the case. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. No prescription was required, and no online consultation was necessary. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site.

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