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Thus, vendors targeting foreign-language speakers in the United States would have been missed. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. This practice also occurs in the United States even though the United States regulates the acquisition of antibiotics, which will be limited by prescription only. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. 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 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. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. 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. There are several limitations to this study. Our purchase arrived from Mexico with no information on instructions for use of the medication. Fifth, we estimated the expected delivery time to take antibiotics. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet.