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Fourth, we have limited our count to English language websites. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. There are several limitations to this study. In the case of online histories to justify a prescription, we assumed that individuals are primarily purchasing antibiotics for an acute problem. No prescription was required, and no online consultation was necessary. 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. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. 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. First, although all of the included providers would sell antibiotics without a prescription, we assessed whether the supplier would sell antibiotics without any form of prescription or whether a prescription created for the purchase based on the completion of an online medical history was required. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. After completing the online medical history, the customer would be given a prescription that would allow the purchase to be completed.