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For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. We classified Web sites of vendors according to several variables. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with 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. 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. 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. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. Previous research suggests that a patient's past experience of care seeking and treatment use influences future expectations for treatment of respiratory tract infections. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. 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. 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. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. This activity suggests that some vendors are aware of the questionable legitimacy of their business.