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Because of its effect on morbidity and mortality, antibiotic resistance is considered a threat to US health and national security by the Institute of Medicine and the Infectious Diseases Society of America. There are several limitations to this study. 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. This activity suggests that some vendors are aware of the questionable legitimacy of their business. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. If those who are self-medicating are taught that they put their own health at risk, they may be less likely to use these online pharmacies. The extended delay between diagnosis and treatment receipt has consequences for resolving self-limiting conditions and storing unused treatment. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. 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. 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. Although excessive consumption of antibiotics has contributed to the spread of antibiotic resistance, 4-6 most initiatives regarding inappropriate direct human consumption of the antibiotic therapy center are almost exclusively controlled by prescribing by healthcare clinicians. 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. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. The extent to which antibiotics are available for over-the-counter purchases over the Internet is unknown.