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This phenomenon has not been the focus of initiatives to control antibiotic resistance. 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. The frequency of relevant Web sites declined substantially after the first 300. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. The vendors identified in this study do not appear to be fearful of prosecution. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. 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. 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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. Fourth, we have limited our count to English language websites. 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. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Third, we categorized the classes of antibiotics available for purchase.