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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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Third, we categorized the classes of antibiotics available for purchase. Fourth, we have limited our count to English language websites. Although the vast majority of websites were in English, some were in other languages. 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. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Our purchase arrived from Mexico with no information on instructions for use of the medication. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated.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. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. 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. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics.