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There are several limitations to this study. That these companies can be located in countries outside US jurisdictions complicates enforcement of US laws. All these obstacles cause the illegal acquisition of antibiotics by patients. 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). For this second group, no prescription from a doctor or clinical physician was necessary before gaining access to the site. Increased regulation of sites outside of controlled substances to include antibiotics seems guaranteed and necessary. 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. Fourth, we have limited our count to English language websites. Some Internet vendors also attempt to skirt US regulations by operating in countries outside the United States but marketing to US consumers. 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. 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. 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. Several studies suggest that antibiotic prescribing for viral illnesses, respiratory tract infections being one example, has declined in the last decade. As a result, most community assessments of antibiotic reservoirs are based on assessments by prescribing clinician behavior.