Treatment for acute bacterial pharyngitis,how to get rid of mac virus 68,signs of bacterial infection in mouth,how to get rid of shaving red spots - Good Point

admin | What Antibiotics Treat Bv | 07.03.2014
Sialadenitis is the inflammation of the salivary glands, the glands that produce saliva in our mouths.
The pus collected from the salivary duct will be taken for laboratory testing and antibiotics will be prescribed to you by your dentist or doctor.
This may also develop following acute sialadenitis, particularly if the acute condition was not treated adequately or causative factors not removed. A common acute viral disease that mainly affects the parotid glands, mumps is highly infectious and is the most common cause of acute parotid swelling. Radiation sialadenitis is a common complication of radiotherapy directly related to the dose of radiation given. X-rays, sialography, CT, MRI or ultrasonography are taken to determine the position of the stone. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Study objective: Comparison of efficacy and safety of sparfloxacin vs ofloxacin for treatment of acute bacterial exacerbations of chronic bronchitis (ABECB). Setting: Sixty-eight private offices and outpatient clinics in the United States and Canada. Patients: Seven hundred ninety-eight adults with ABECB, as confirmed by the acute onset of new (or worsened from the immediate premorbid state) cough and sputum production. Results: The primary efficacy parameter was overall response in the bacteriologically evaluable population.
Conclusions: Once-daily oral treatment with 200 mg sparfloxacin (after initial 400 mg dose) is as effective as twice-daily treatment with 400 mg ofloxacin in patients with ABECB. Chronic bronchitis, which is characterized by a history of cough with excessive sputum production occurring on most days for at least 3 months of the year for 2 successive years, is exhibited by as many as 25% of adults in the United States.[1,2] The etiologies of this condition include cigarette smoking, air pollution, bronchopulmonary infections, and other toxic stimuli.
Controversy about the efficacy of antibiotic therapy for ABECB has resulted from conflicting clinical trial results, due partially to study design differences and modest success rates. Sparfloxacin is a synthetic, broad-spectrum, fluoroquinolone antibacterial agent for oral administration that is more active in vitro against common respiratory pathogens than other available quinolones.[7,11,12] Sparfloxacin is a potent inhibitor of bacterial DNA gyrase and is bactericidal at or near the minimum inhibitory concentration (MIC). This was a double-blind, randomized, multicenter, comparative study involving approximately 800 patients with ABECB randomized 1:1 to receive either sparfloxacin (400 mg loading dose followed by 200 mg once daily) or ofloxacin (400 mg twice daily) for 10 days.
Adult patients ([is greater than or equal to] 18 years of age) presenting with ABECB could be enrolled in the study. Female patients of childbearing potential were not eligible for study participation unless they were using reliable contraception. Because a small increase in corrected QT interval (QTc) interval is caused by sparfloxacin treatment,[21] patients were excluded for congenital prolonged QT syndrome, concurrent use of antiarrhythmic agents or other medications known to cause QT prolongation, or baseline QTc interval [is greater than] 500 ms. Patients were evaluated at baseline (visit 1), during treatment (visit 2), 10 days posttreatment (visit 3 [test-of-cure]), and 28 days posttreatment (visit 4 [follow-up]).
A sputum specimen[22] for Gram's stain, routine culture, and susceptibility was obtained at all visits and at premature discontinuation. Bacteriologic response was determined for each patient in the bacteriologically evaluable and all-treated with a baseline pathogen populations at the test-of-cure assessment.
The primary efficacy variable was overall response in the bacteriologically evaluable patient population. All randomized patients who received at least one dose of study medication constituted the all-treated population.
All randomized patients who received at least one dose of study medication were assessed for safety. Sample size calculations were based on a two-sided 95% confidence interval method of establishing equivalence of two proportions with an assumed overall response success rate (cured plus improved) of 90% in the ofloxacin group. Differences between treatment groups in the distribution of demographic variables and baseline characteristics were tested using two-way analysis of variance for continuous variables and the Cochran-Mantel-Haenszel test for categorical variables. Pathogens identified in [is greater than or equal to] -10 patients are summarized in Table 3.
Statistical equivalence of sparfloxacin 200 mg once daily (after initial 400 mg dose) to ofloxacin 400 mg every 12 h for 10 days was demonstrated for the primary efficacy parameter, overall success in the bacteriologically evaluable population, and for clinical success in the clinically evaluable population. Clinical success rates for both treatment groups did not vary as a function of gender, race, age, medical history (cigarette, alcohol, and illicit-drug use), recent hospitalization, underlying condition (COPD, or other lung disease, coronary artery disease, or diabetes mellitus), or bacteriologic status at entry (number of pathogens at study entry). Bacteriologic Efficacy: Success rates for the most frequently isolated pathogens are shown in Table 5 for the all-treated patients with a baseline pathogen population and in Table 6 for the bacteriologically evaluable population. The percentage of patients reporting an adverse event was comparable between the two treatment groups. Most adverse events reported for patients in both treatment groups were of mild or moderate severity. Changes in vital signs, physical examination, and laboratory parameters were similar in the two groups. Administration of once-daily sparfloxacin for 10 days was shown to be effective for the treatment of ABECB and equivalent to ofloxacin administered twice daily for 10 days.
Emerging bacterial resistance, particularly in strains of S pneumoniae, is a concern in the treatment of patients with ABECB. Increased rates of [Beta]-lactamase-mediated resistance have also been observed in other causative pathogens, such as H influenzae (approximately 45 to 50%) and M catarrhalis (approximately 100% of clinical isolates). In the current study, pathogen eradication rates for sparfloxacin were consistent with in vitro activity. There was a high incidence of positive serology for C pneumoniae from patients in both treatment groups; C pneumoniae was the sole etiologic organism for 14 patients in the sparfloxacin group and 13 patients in the ofloxacin group. Modest QTc prolongation was observed in the sparfloxacin group but was not associated with any cardiovascular adverse event. An advantage of sparfloxacin therapy is the once-daily dosing regimen compared with the twice-daily dosing regimen of ofloxacin. In conclusion, oral treatment with sparfloxacin is effective, and comparable to ofloxacin, for the treatment of ABECB. Orbactiv (oritavancin) is the first and only approved antibiotic for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible Gram-positive bacteria.It was originally discovered by Eli Lilly, but was later acquired by InterMune and Targanta Therapeutics in 2001 and 2005 respectively for the development. The treatment of ABSSSI becomes difficult due to increased resistance among gram-positive and gram-negative bacteria.
Methicillin-resistant Staphylococcus aureus (MRSA) is declared as a serious public health threats by the US Centers for Disease Control and Prevention (CDC).
The uncomplicated category ABSSSI includes simple abscesses, impetiginous lesions, furuncles, and cellulitis.
Even though most patients with acute rhinosinusitis recover promptly without it, antibiotic therapy should be considered in patients with prolonged or more severe symptoms.
Any soft swelling should be surgically drained and supportive therapy, such as adequate fluid intake, painkillers and practice of good oral hygiene, is important. If the stone is within the duct, the stone can be removed with the duct but if the stone is within the gland, the entire gland will have to surgically removed. Infection in severely damaged salivary glands is often irreversible but with less damage, some degree of salivary gland function may return after several months. Abnormalities in the bronchial system resulting from chronic bronchitis, such as obstructed bronchioles, impaired mucociliary clearance, and chronic bacterial infections of bronchial epithelium, may predispose the patient to acute bacterial infection.[3] Acute bacterial exacerbations of chronic bronchitis (ABECB) are manifested by marked increase in cough and sputum production, often accompanied by increased sputum purulence. A double-dummy system was used such that matching comparator placebos were given concurrently with the active drug during the treatment period. The diagnosis of ABECB required the presence of chronic bronchitis (ie, history of cough with production of sputum occurring on most days for at least 3 months of the year for at least 2 successive years) and an ABECB as confirmed by the acute (within 14 days) onset of new (or worsened from the immediate premorbid state) cough and sputum production.
Patients with the inability to minimize unprotected exposure to sunlight were 'also excluded from the study because of the photosensitizing effect of sparfloxacin documented in early clinical studies.
Investigators reviewed each patient's concomitant medications to identify potential drug interactions. The following categories were used for assessing the bacteriologic response to baseline pathogens from sputum cultures: eradication (absence of a pathogen at a postbaseline visit that was present at baseline), presumed eradication (no material available for culture at a postbaseline visit, for a pathogen that was present at baseline, with a corresponding clinical response of cured or improved), persistence (presence of a baseline pathogen at a postbaseline visit), presumed persistence (no results from a culture at a postbaseline visit for a pathogen, that was present at baseline, with a corresponding clinical response of failure), superinfection (emergence of a new organism that was not identified as a causative pathogen at baseline, accompanied by signs or symptoms of ABECB), multiple pathogens with partial eradication (eradication of at least one baseline pathogen, with persistence of at least one baseline pathogen), and indeterminate (no information on any baseline pathogen). Any patient who had a clinical response of cure or improvement (as determined by the investigator at the test-of-cure visit) and a bacteriologic response of either eradicated or presumed eradicated was deemed a success. The all-treated "with a baseline pathogen population consisted of a subset of the all-treated population who had at least one baseline pathogen.


It was determined that 190 patients per treatment group would be required to have all 80% probability of showing that sparfloxacin did not differ from ofloxacin by [is greater than]10% in either direction.
A higher percentage of patients (approximately 80%) had an identifiable respiratory pathogen than estimated a priori (50%). Comparable numbers of isolates of each organism were obtained from patients in both treatment groups, with H parainfluenzae being the most frequently isolated pathogen (approximately 29%).
Other identified pathogens included A anitratus, A lwoffi, Chlamydia spp, C psittaci, Comamonas acidovorans, E cloacae, Klebsiella oxytoca, N meningitidis, Streptococcus marcescens, Streptococcus group G, Streptococcus agalactiae, and Streptococcus pyogenes. The results of the all-treated population analyses were similar to those of the evaluable populations for overall and clinical success. Results for each pathogen in the all-treated patients with a baseline pathogen population were similar to those of the evaluable population. Approximately 87% of bacteriologically evaluable patients in the sparfloxacin group and 92.6% of bacteriologically evaluable patients in the ofloxacin group were considered bacteriologic successes. A summary of the most frequently reported related adverse events (at least 2% of patients in a treatment group) is presented in Table 8.
Equivalence was demonstrated for the primary efficacy parameter of overall response in the bacteriologically evaluable patient population, as well as for clinical success in the clinically evaluable population. Currently, approximately 25% of S pneumoniae strains have intermediate or high level resistance to penicillin, with a higher rate anticipated by the next decade,[12] All [Beta]-lactam antimicrobials have decreased activity against this pathogen. All photosensitivity reactions in patients who received sparfloxacin were of mild or moderate severity, except for one patient treated before the protocol amendment that further enhanced instructions regarding sparfloxacin-related photosensitivity (see "Results" section).
The QTc effect of sparfloxacin has been described previously.[21] The major consideration in prescribing is avoidance of coprescription of sparfloxacin with other QTc-prolonging agents, especially antiarrhythmics such as amiodarone.
Sparfloxacin is effective against the major causative pathogens, including H influenzae, S pneumoniae, M catarrhalis, C pneumoniae, H parainfluenzae, K pneumoniae, E cloacae, and S aureus. All investigator sites received a fee per included patient to cover the expenses of the procedures. The development rights of Orbactiv were finally acquired by The Medicines Company in 2009.The Medicines Company submitted New Drug Application (NDA) for Orbactiv to the US Food and Drug Administration (FDA) in the fourth quarter of 2013.
The patients were randomised in two identical double-blind, multi-centre, multinational, non-inferiority trials.Orbactiv was compared with vancomycin in both the trials. To avoid the emergence and spread of antibiotic-resistant bacteria, narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days. Eighty-one percent of patients treated with antibiotics and 66 percent of the control group were cured or improved, meaning one patient benefited for every seven treated with antibiotics. Once the acute condition has resolved, the causative factors, such as duct stones, are to be identified and corrected. However, increasing resistance of organisms to these commonly utilized antibiotics presents a challenge in the treatment of ABECB. This study was initiated to compare the efficacy and safety of sparfloxacin with the efficacy and safety of ofloxacin in the treatment of ABECB. If the immediate premorbid state (ie, the patient's stable baseline condition in the 60 days prior to the onset of the current exacerbation of symptoms) included sputum production, the patient must have had both an increased volume and an increased purulence of the sputum produced. The protocol was amended in October 1993 to provide new information regarding sparfloxacin-associated photosensitivity and additional precautions regarding sun exposure.
Patient compliance with the study drug regimen was assessed during therapy and at the test-of-cure assessment, and safety was monitored during treatment, at test-of-cure assessment, and at follow-up.
Sputum samples (including Gram-stained and unstained slides of sputum) were sent to a central laboratory (SciCor Laboratories; Indianapolis) for review of the Gram's stain and identification of etiologic pathogens and susceptibility testing. Any patient with a clinical response of failure or a bacteriologic response of persistence, presumed persistence, superinfection, or multiple pathogens with partial eradication was considered a failure. Given an expected attrition rate of approximately 10%, and an expectation that 50% of enrolled patients would have an identifiable respiratory tract pathogen, total study enrollment was estimated a priori at 850 patients.
The two-sided 95% confidence interval for the difference in treatment response rates was used to determine equivalence between sparfloxacin and ofloxacin for efficacy variables.
The number and percentage of patients in each population for both treatment groups are presented in Table 1.
For the all-treated population, bacteriologic success was equivalent between the treatment groups, and bacteriologic success in the bacteriologically evaluable population approached statistical equivalence; the 95% confidence interval was slightly below the equivalence range (Table 4).
The 95% confidence interval for the difference between the two treatment groups in clinical success rate supports equivalence of the two treatments for both the all-treated and evaluable populations.
Of note is that five of five S pneumoniae strains in the sparfloxacin group and three of three S pneumoniae strains in the ofloxacin group exhibiting decreased susceptibility to penicillin were eradicated or presumed eradicated after treatment with study medication. The 95% confidence interval for the difference between the two treatment groups in bacteriologic success rate supports equivalence of the two treatments for the all-treated patients with baseline pathogen populations; bacteriologic success approached equivalence in the bacteriologically evaluable populations. The 95% confidence interval for the difference between the two treatment groups in overall response rate supports equivalence of the two treatments in both the all-treated and evaluable populations.
Three patients who received sparfloxacin and three patients who received ofloxacin developed a superinfection. Overall, the most common related adverse events were insomnia, nausea, and photosensitivity reaction.
Sparfloxacin administration appeared to have no effect on serum digoxin or serum theophylline concentrations; the same was true for ofloxacin, although the small number of patients who received digoxin precluded treatment group comparison. No significant differences were observed between the two treatment groups for the mean change from baseline to maximum off-treatment values for QTc interval. Bacteriologic success in the bacteriologically evaluable population approached statistical equivalence. In general, C pneumoniae infection was rarely diagnosed in most previous studies of patients with ABECB since serology for atypical pathogens was usually not performed. Approximately one half of the adverse events reported were considered by the investigator to be possibly or probably related to study medication. In addition to its efficacy, the advantages of a once-a-day regimen and high bronchial penetration make sparfloxacin an alternative for the treatment of ABECB in those patients who are not at risk for photosensitivity reactions or cardiovascular complications of a QTc interval increase.
Sialadenitis is usually caused by bacterial or viral infection but the disorder can occasionally be due to other causes, such as trauma, radiation and allergic reactions. Fluoroquinolones are an alternative since they are not destroyed by [Beta]-lactamase-producing organisms and are therefore effective against Gram-negative pathogens such as H influenzae and M catarrhalis. This study was conducted in compliance with institutional review board regulations and was monitored according to good clinical practices. Gram's stain of' a purulent or mucopurulent sputum specimen obtained within 48 h prior to starting treatment with the study medication had to show [is greater than] 25 neutrophils and [is less than] 10 squamous epithelial cells per low-power field. Patient weight was determined at test-of-cure and chest radiograph was repeated at premature discontinuation or at follow-up if pneumonia was suspected.
Patients were advised to avoid exposure to direct or indirect sunlight and artificial ultraviolet light (eg, sunlamps) during treatment with study drug and for several days after therapy.
All bacteria considered to be pathogenic were identified to genus and species and tested for susceptibility to sparfloxacin and ofloxacin according to the National Committee for Clinical Laboratory Standards guidelines.[23,24] Susceptibility was performed by the broth dilution (MIC) method for ofloxacin and by MIC and disk (Kirby-Bauer) for sparfloxacin. Patients who discontinued before test-of-cure were evaluated as failures only if they received 2 full days of study medication.
Bacteriologic success rates did not vary substantially for monomicrobic vs polymicrobic infection. In the sparfloxacin group, superinfecting organisms were S pneumoniae (two) and Pseudomonas aeruginosa (two). The percentages of patients who experienced related nausea and insomnia were lower in the sparfloxacin group as compared with the ofloxacin group. Related adverse events leading to discontinuation in the ofloxacin group were rash, diarrhea, nausea, dyspepsia, vomiting, insomnia, agitation, abnormal dreams, hyperkinesia, and urticaria. The results of all-treated patient population analyses were similar to those of the evaluable patient populations; additionally, statistical equivalence was demonstrated for bacteriologic success in this population. All five strains of S pneumoniae with decreased susceptibility to penicillin were eradicated or presumed eradicated by sparfloxacin treatment. A small percentage of patients experienced adverse events that led to discontinuation from the study by the investigator.
Second-line antibiotics should be considered if the patient has moderate disease, recent antibiotic use (past six weeks), or no response to treatment within 72 hours.


Theoretically, ipratropium may increase the viscosity of mucus and impair its clearance, but this effect appears to be less prominent with ipratropium than with antihistamines.31Most studies of intranasal steroids in patients with ABRS have not shown an effect on clinical outcomes. Bacterial eradication rates were similar in both treatment groups for Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Enterobacter cloacae, and Staphylococcus aureus. Some quinolones also have activity against S pneumoniae, including multidrug-resistant strains.
Patients may also have had fever (temperature[is greater than] 38.0 [degrees] C by the oral route), wheezing, and shortness of breath. Chest radiographs were read and interpreted by a radiologist and documented in a signed and dated written report. Safety parameters included adverse clinical and laboratory events, and changes in ECG, vital sign, and physical examination findings. Isolation and identification of C pneumoniae by accepted laboratory methods was attempted at baseline and posttreatment visits, and at premature discontinuation. The investigator also evaluated clinical recurrence (development of new or worsened signs and symptoms) at follow-up for those patients demonstrating clinical success at the test-of-cure assessment. The bacteriologically evaluable population was a subset of the clinically evaluable population who had an identified lower respiratory tract pathogen. Eighty-one percent of the patients were clinically evaluable and 61.2% of the patients were bacteriologically evaluable. In the ofloxacin group, superinfecting organisms were Acinetobacter lwoffi (one), Enterobacter cloacae (one), Stenotrophomonas maltophilia (one), S pneumoniae (one), and Klebsiella pneumoniae (one).
The percentage of patients who experienced a related photosensitivity reaction was higher in the sparfloxacin group as compared with the ofloxacin group.
No adverse event leading to discontinuation occurred at an incidence of [is greater than or equal to] 2% in either treatment group. The bacteriologic success rate for S pneumoniae in the sparfloxacin group is similar to that documented in other studies (approximately 90 to 96%),[27-29] but in the ofloxacin group, it was somewhat higher in this study than previously reported (approximately 40 to 79%).[30-32] Eradication rates for commonly occurring Gram-negative organisms in patients with ABECB (H parainfluenzae, H influenzae, and M catarrhalis) were also similar in the two treatment groups. Amoxicillin-clavulanate potassium and fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae.
The first patient entered the study in November 1992 and the last patient completed the study in October 1994. A chest radiograph confirming the absence of pulmonary findings consistent with pneumonia was required. The QTc interval was determined either manually by the investigator or ECG-machine calculated.
Each case of C pneumoniae infection was diagnosed on the basis of a fourfold or greater increase in IgG titer or on the basis of appearance of IgM.
As shown in Table 2, most of the all-treated patient population in each treatment group were white, while the percentages of male and female patients were similar. Seven patients in the sparfloxacin group and nine patients in the ofloxacin group also developed colonization. A single sparfloxacin patient experienced a severe photosensitivity rash to the hands, neck, face, and left arm that was considered by the investigator to be probably related to study medication. One patient in the ofloxacin group died due to arteriosclerotic and hypertensive cardiovascular disease that was considered remotely related to ofloxacin. MRSA is declared as a serious public health threat by the US Centers for Disease Control and Prevention (CDC).
The company operates in various locations including the US, Europe, Middle East and Asia Pacific regions.The company plans to launch Orbactiv in the US market in the second half of 2014. In patients with beta-lactam hypersensitivity who have moderate disease, a fluoroquinolone should be prescribed. The rapid emergence of antibiotic-resistant organisms associated with ABRS has made choosing an antibiotic more difficult. The sparfloxacin group had a lower frequency of digestive and nervous system adverse events, but a higher frequency of photosensitivity reactions than the ofloxacin group.
An assessment of the patient's response to study drug treatment was made at test-of-cure (or premature discontinuation before test-of-cure); recurrence of infection was determined at follow-up (or premature discontinuation after test-of-cure).
Adverse events were recorded and classified by the investigator as to severity and relationship to study drug medication.
A progressive fourfold decrease in C pneumoniae IgG titer was accepted as evidence of acute infection in the absence of a pathogen identified by culture. There were no statistically significant differences in demographic characteristics between the sparfloxacin and ofloxacin groups with the exception of a lower mean body weight in the sparfloxacin group as compared with the ofloxacin group. According to CDC's estimates, approximately 80,000 MRSA related cases are recorded in the US every year leading to 11,000 MRSA related deaths. Other medications available in the market to treat ABSSSI include Dalvance (dalbavancin) developed by Durata Therapeutics and Sivextro developed by Cubist Pharmaceuticals. Surveillance studies have shown an increasing prevalence of antibiotic-resistant Streptococcus pneumoniae.12,13 Up to 25 percent of these bacteria are penicillin resistant, and 15 percent are penicillin intermediate. Patients could withdraw from the study at any time at their discretion or could be discontinued by the investigator for medical or administrative reasons. The pathogens most frequently associated with relapse in the sparfloxacin group were H influenzae and H parainfluenzae. This adverse event occurred before the October 1993 protocol amendment that further enhanced instructions regarding sparfloxacin-related photosensitivity.
Decongestants often are recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion. Controlled studies of mist use in URI have not shown a benefit.42,43Guaifenesin (Hytuss), a mucolytic agent, should improve mucus clearance by thinning secretions, but there is no evidence of clinical benefit. Demographic and other baseline characteristics of clinically evaluable patients were similar to those of the all-treated patients.
Topical ipratropium and the sedating antihistamines have anticholinergic effects that may be beneficial, but there are no clinical studies supporting this possibility. Other isolated pathogens associated with bacterial relapse were in catarrhalis, S pneumoniae, and K pneumoniae in both treatment groups, Acinetobacter anitratus in the sparfloxacin group, and Serratia marcescens, Neisseria meningitidis, and P aeruginosa in the ofloxacin group. The study was presented, in part, at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, September 15-18, 1996. Nasal irrigation with hypertonic and normal saline has been beneficial in chronic sinusitis and has no serious adverse effects. Mist, zinc salt lozenges, echinacea extract, and vitamin C have no proven benefit in the treatment of acute bacterial rhinosinusitis.
In this article, the evidence supporting different treatments for acute bacterial rhinosinusitis (ABRS) is reviewed.
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TMP-SMX and doxycycline are alternatives for use in patients who are allergic to beta lactams, but they have limited coverage for H. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis.
Amoxicillin-clavulanate potassium and fluoroquinolones (gatifloxacin [Tequin], levofloxacin, and moxifloxacin [Avelox]) currently have the best coverage for H. More recently, five-day treatment courses with azithromycin and telithromycin (Ketek) were found to be effective.24,25TREATMENT FAILUREWhen a patient fails to respond to therapy, additional history, physical examination, cultures, or imaging may be necessary.
If a change in antibiotic therapy is made, the limitations in coverage of the initial antibiotic should be considered. Specialization, Materia Medica, internal medicine, diagnosis , examine, refer ,investigations .health shops, pharmacies, prescription, complex remedies, labelled ,individualized ,mental, migraines, asthma, eczema, hay fever, glandular fever, chronic fatigue syndrome. Free-radical, toxin-, inflammatory, degenerative diseases, Nutrients, minerals, enzymes, vitamins, amino acids.



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