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This decrease was interpreted as evidence that the full use of antibiotics was also reduced. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. Third, we categorized the classes of antibiotics available for purchase. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. For example, we found that servers at Dartmouth College, East Carolina University, University of Pittsburgh, Carnegie Mellon University, and California State University in San Francisco were all used, most likely without their knowledge, to be reassigned to online pharmacies. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. 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. 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. 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. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Our final list of URLs included 184 links to single vendors of antibiotics. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care.