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That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. Finally, and potentially the biggest limitation on the importance of this study, is that we were unable to describe how this Internet-based purchasing strategy was used to purchase people with antibiotics in the United States. As part of this study, we bought over-the-counter antibiotics over the counter. Since the websites suggested a range of days for the expected treatment receipt, we used the median to represent the expected delivery time. The medical community and the public health and regulating agencies, as well as pharmaceutical companies, need to expand efforts to control antibiotic resistance beyond initiatives centered on prescribing behavior to include self-medication and sources of antibiotics obtained without prescription. We classified Web sites of vendors according to several variables. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. 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. In our analysis of evidence of the concept of buying 6 tablets of azithromycin, 500 mg each. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. We compared identifying telephone numbers, street addresses, and site headers for each site as a way to sort out duplication. 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. 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. As some vendors have multiple URLs to reach their company, we checked the mailing address, title and phone number to avoid double counting.