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We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. There are several limitations to this study. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Fourth, we have limited our count to English language websites. Fifth, we estimated the expected delivery time to take antibiotics. In conclusion, antibiotics are freely available for purchase over the Internet without a prescription, and the general structure of transactions encourages self-medication and poor quality care. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. As part of this study, we bought over-the-counter antibiotics over the counter. 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.

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