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The vendors identified in this study do not appear to be fearful of prosecution. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Our final list of URLs included 184 links to single vendors of antibiotics. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. No prescription was required, and no online consultation was necessary. 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. 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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