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This study was not meant to be an exhaustive census of these sites, primarily because with the questionable legality of some of these practices, these sites rapidly come and go. We assessed whether individuals could purchase penicillins, macrolides, fluoroquinolones, and cephalosporins, because the availability of multiple classes of antibiotics would affect additional selective pressure in the community. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. 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 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. 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. Fifth, we estimated the expected delivery time to take antibiotics. We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. Some prescription medication is sold without a valid prescription, which is a violation of the Federal Food, Drug, and Cosmetic Act. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. 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. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents.