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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. 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. We therefore wanted to find out if the amount of time between online evaluation and getting treatment was significantly longer. Although the vast majority of websites were in English, some were in other languages. 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. 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. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. 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. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. Fourth, we have limited our count to English language websites. Patients are increasingly using the Internet not only to access health information but also to obtain medication. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Although providing over-the-counter drugs is illegal in the United States, failure to enforce US laws likely encourages these companies to sell their products to patients. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time.