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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. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed. 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. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. 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. Fourth, we have limited our count to English language websites. Our purchase arrived from Mexico with no information on instructions for use of the medication. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. 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. No prescription was required, and no online consultation was necessary. This reservoir of antibiotics is likely to be used inappropriately-the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages.