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This phenomenon has not been the focus of initiatives to control antibiotic resistance. No prescription was required, and no online consultation was necessary. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. In usual face-to-face health care visits for respiratory tract infections during which antibiotics are prescribed, more than 90% of prescriptions are filled on the day of the office visit. 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. 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business. Third, we categorized the classes of antibiotics available for purchase. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each.