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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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. The first 300 search results of on both sites were examined to identify vendors for antibiotics that did not require a prescription. 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. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. 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. No prescription was required, and no online consultation was necessary. Third, we categorized the classes of antibiotics available for purchase. Although the vast majority of websites were in English, some were in other languages. In addition, the ability of Internet-based companies to exist without an identifiable physical location or property makes the location and writing of FDA instructions extremely difficult. This activity suggests that some vendors are aware of the questionable legitimacy of their business. European countries struggled with the problem of self-medication with antibiotics and found that the belief in the appropriateness of self-medication with antibiotics for bronchitis and the perceived availability of antibiotics without a prescription was associated with an increased likelihood of self-medication. We classified Web sites of vendors according to several variables.

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