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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. No prescription was required, and no online consultation was necessary. The US Food and Drug Administration forbids ordering prescription drugs from outside the United States: Thus, in virtually all instances, individual citizens are prohibited from importing prescription drugs into the United States. 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. 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. Fourth, we have limited our count to English language websites. 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. Patients are increasingly using the Internet not only to access health information but also to obtain medication. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated.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. Our study suggests that the opposite might be the case. Clinicians evaluating the patient's use of self-medication when taking a medical history may function as an important opportunity to tell patients about not only antibiotic resistance, but also potential interactions between antibiotics and other prescription drugs. All these obstacles cause the illegal acquisition of antibiotics by patients.