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Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The links to these advertised sites were also investigated. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. Patients are increasingly using the Internet not only to access health information but also to obtain medication. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. Our study is the first to document this phenomenon, and we describe the mechanism for purchasing antibiotics online; future studies will need to document the scope of antibiotics purchased through this mechanism to better understand its direct implications for antibiotic resistance. 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.