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There are several limitations to this study. The links to these advertised sites were also investigated. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Although the vast majority of websites were in English, some were in other languages. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. 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. As part of this study, we bought over-the-counter antibiotics over the counter. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Fifth, we estimated the expected delivery time to take antibiotics.