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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. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. 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. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. 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. Our purchase arrived from Mexico with no information on instructions for use of the medication. 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. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008.

J. Howard Knox Child Development