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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. Although the vast majority of websites were in English, some were in other languages. 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. Third, we could not to determine how often pharmaceuticals purchased over the Internet were not genuine, inactive, out of date, or adulterated. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. 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. Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. All these obstacles cause the illegal acquisition of antibiotics by patients. 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. Our study suggests that the opposite might be the case. In some cases the URL did not take the reader to an actual medication vendor; rather, the Web site contained multiple advertisements and links to other sites for purchasing antibiotics. 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). This phenomenon has not been the focus of initiatives to control antibiotic resistance.