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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. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. Recent evidence in ethnic communities in the United States indicates a high level of self-medication with antibiotics either obtained without a prescription in a foreign country and imported into the United States or acquired in the United States without a prescription at stores in ethnic communities. 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. In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. 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. 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. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment.