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Third, we categorized the classes of antibiotics available for purchase. This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. The frequency of relevant Web sites declined substantially after the first 300. 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. 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. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Thus, vendors targeting foreign-language speakers in the United States would have been missed. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. We classified Web sites of vendors according to several variables. 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. 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. 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. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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.