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Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. 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. 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. 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. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. 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. 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.