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This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. This phenomenon has not been the focus of initiatives to control antibiotic resistance. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Our purchase arrived from Mexico with no information on instructions for use of the medication. Thus, vendors targeting foreign-language speakers in the United States would have been missed. We classified Web sites of vendors according to several variables. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. 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. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. The vendors identified in this study do not appear to be fearful of prosecution. 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.

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