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We considered more than 6 pills to be excessive and could lead to future self-medication with the unused pills. 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. Further education aimed at patients and the community, as well as increased regulation and application of existing guidelines, can help control this potentially vast reservoir of antibiotics. Moreover, pharmaceutical companies may need to monitor who is selling their products and through what mechanisms. The frequency of relevant Web sites declined substantially after the first 300. 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. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. Thus, as soon as patients receive over-the-counter antibiotics and self-treating self-limiting illnesses with drugs, such as upper-respiratory tract infections without complications, they are likely to suggest that the antibiotic was effective, and self-medicate in the future. 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. Unfortunately, other disturbing evidence suggests that this problem may not be easily fixed through education, a troubling issue in controlling antibiotic use. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. Third, we categorized the classes of antibiotics available for purchase. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). No prescription was required, and no online consultation was necessary. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws.