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Specifically, we classified a single course of azithromycin as 6 pills, 250 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. Second, we examined whether the vendor would ship prescription antibiotics to a buyer in the United States, as well as several other countries (Canada, United Kingdom) where antibiotics are available only by prescription. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. 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. 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. This phenomenon has not been the focus of initiatives to control antibiotic resistance. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. Our final list of URLs included 184 links to single vendors of antibiotics. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. Fourth, we categorized whether a person could buy antibiotics, especially broad-spectrum antibiotics, in quantities greater than what would be considered adequate 1 course of treatment for acute respiratory tract infection.