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Although the vast majority of websites were in English, some were in other languages. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. The findings described in this study suggest that there is a potentially large pool of antibiotics in the United States that is not affected by initiatives to change physician-prescribing practices and may be contributing to antibiotic resistance. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Patients are increasingly using the Internet not only to access health information but also to obtain medication. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. The frequency of relevant Web sites declined substantially after the first 300. 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. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. 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. All these obstacles cause the illegal acquisition of antibiotics by patients.