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All these obstacles cause the illegal acquisition of antibiotics by patients. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. We classified Web sites of vendors according to several variables. Even with these strategies, however, it was difficult to know whether one corporation still owns and manages several locations. 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. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. 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. 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. 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. Thus, vendors targeting foreign-language speakers in the United States would have been missed. 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.