where can you buy the abortion pill

There he could simply order medical abortion pill online generic.There we could simply order generic cytotec abortion. Secure mifepristone and misoprostol every twelve hours tablets.

cheapest biaxin

order clarithromycin 500mg buy clarithromycin buy biaxin australia

purchase biaxin

buy clarithromycin 500mg buy clarithromycin pills purchase clarithromycin

cheap biaxin

buy biaxin uk buy clarithromycin buy biaxin pills

buy discount clarithromycin

buy biaxin 250mg buy clarithromycin usa cheapest biaxin

purchase clarithromycin

purchase biaxin purchase clarithromycin buy biaxin no prescription

generic clarithromycin

clarithromycin online buy clarithromycin buy clarithromycin australia

order clarithromycin

clarithromycin reviews buy clarithromycin biaxin reviews

order clarithromycin 500mg

order clarithromycin buy biaxin australia buy clarithromycin online

cheapest clarithromycin

purchase clarithromycin http://www.geospatialworld.net/Event/View.aspx?EID=63#buyclarithromycin buy clarithromycin

buy cytotec for 24 week abortion

pill for abortion online abortion pill buy the abortion pill online

i need to buy the abortion pill

ordering abortion pills to be shipped to house http://www.cengage.co.in/content/privacy-statement order abortion pill

medical abortion pill online

abortion pill online ordering abortion pills to be shipped to house cytotec abortion

cytotec abortion pill buy online

order abortion pill online http://www.geospatialworld.net/Event/View.aspx?EID=53 i need to buy the abortion pill

abortion pill online purchase

abortion pill prescription abortion pill buy abortion pills online

women does viagra work

viagra reviews viagra pharmacy cheap viagra tablets

cialis vs kamagra

alternative to kamagra cheap kamagra kamagra canada

kamagra jelly jokes

buy kamagra jelly online safe mail order kamagra jelly kamagra jelly jokes

cialis vs amoxicillin

get amoxil http://www.cengage.co.in/content/academic-professional amoxil equivalent

buy cheap thyroxine online uk

synthroid prescription synthroid women does synthroid work

get discount laxative online

free bisacodyl sample http://www.cengage.co.in/content/library-reference get discount bisacodyl online

fedex generic principen

buy ampicillin online principen without prescription natural principen alternatives

how to order the abortion pill online

buy abortion pills online where can i buy abortion pills cytotec abortion

cheapest biaxin

buy cheap biaxin http://www3.umu.se/kultmed/kurswebb/default.aspx?id=29 order clarithromycin 250mg

natural cipro

buy cipro online ciprofloxacin buy ciprofloxacin online a href

fedex generic clindamycin

mail order clindamycin clindamycin photos clindamycin

dexamethasone equivalent

buy dexamethasone online http://www.geospatialworld.net/Event/View.aspx?EID=44 buy dexamethasone online a href

female herbal Cefadroxil

female herbal duricef fedex generic Cefadroxil Cefadroxil prescription buy

generic cefpodoxime online

how does vantin work buy vantin online mail order cefpodoxime

free ceftin sample

buy cefuroxime online a href cefuroxime prescription buy ceftin prescription

where can you buy the abortion pill

how to order the abortion pill online where can i buy abortion pills on line abortion pill

how does cephalexin work

purchase cephalexin online free keflex sample get cephalexin avoid prescription

female herbal chloromycetin

buy chloromycetin las vegas chloromycetin for sale chloromycetin prescription

cytotec abortion

buy the abortion pill online buy cytotec for 24 week abortion abortion pill prescription

female herbal augmentin

purchase clavulanate online generic clavulanate how does clavulanate work

cytotec abortion

where to buy abortion pills online i need to buy the abortion pill abortion pill buy online
 About the Journal
 Editorial Board
Subscribe to E- Alerts
Contact Us
Hitzplus Jokes, Wallpapers, Bollywood, Videos and e-cards | Bollywood News, Reviews, Songs, Hindi Bollywood Movies
 
Article Options
FULL TEXT
ABSTRACT
PROVISIONAL PDF
Printer Friendly Version
Search Pubmed for
Search Google Scholar for
Article Statistics
Bookmark and Share
Original Article
 
Trends of prescribing and utilisation of antibiotics in the paediatric out-patient population of a secondary care hospital in Gurgaon, India
Priti Chaudhary, Arti Bahl, Anil Kumar
Department of Epidemiology, National Centre for Disease Control, 22, Shamnath Marg,
New Delhi-110054, India.


Corresponding Author
:
Dr. Priti Chaudhary
Department of Epidemiology, National Centre for Disease Control, 22, Shamnath Marg, 
New Delhi-110054, India.
E-mail: drpritichaudhary@gmail.com


History : Received - 11-Dec-2013 Accepted - 19-Jan-2014 Published Online -  25-Jan-2014
DOI : http://dx.doi.org/10.7713/ijms.2014.0004


Abstract

Background: Antibiotics misuse is a global problem. To study the knowledge and practice regarding antibiotic use in care-givers of children and antibiotic prescription pattern in paediatrics out-patient department of a secondary care hospital at Gurgaon, Haryana, India.

Methods: The present study was undertaken to screen rational use of antibiotics among paediatric out-patient population in Gurgaon. As per WHO guidelines, 100 prescriptions were collected from paediatrics out-patient department and prescriptions containing antibiotics were analysed. One hundred caregivers were interviewed using a structured questionnaire to determine the knowledge of antibiotics.

Results: 45% of patients were prescribed antibiotics and out of the total antibiotics prescribed, 87% were generic drugs, 93% were from the WHO Essential Drugs List and 71% were as per National Formulary of India guidelines. 36% caregivers had knowledge of antibiotics and 14% knew that antibiotics are used for bacterial infections. Very few of the caregivers believed that antibiotics have side-effects (33%), 8% were aware of antibiotic resistance. Knowledge of antibiotics was significantly associated with high education and socio-economic status (p<0.05). A total of 59% parents completed the given course of treatment in their children; others stopped giving medicines after symptoms disappeared (23%), a few days after recovery (17%) and after the medicines got over (1%).

Conclusions: Though the prescription of generic drugs and drugs from WHO Essential Drugs List is satisfactory, the low rate of rational prescriptions and poor knowledge of antibiotics among the caregivers and poor compliance to the given course of treatment is a matter of concern.

Keywords : Anti-bacterial agents, caregivers, outpatient care, pediatrics.

Introduction

Antibiotic resistance is a global problem and antibiotic overuse is cited as the main reason for its development [1,2]. Countries with higher consumption have been found to have higher rate of antimicrobial resistance [3]. Factors leading to antimicrobial overuse in children are complex, involving, among other factors, parental knowledge and attitude, physician beliefs as well as constraints of daily practice [4]. It is estimated that 20-50% of all antibiotic use is inappropriate [5]. As per data, most antibiotic prescriptions for respiratory tract infections (RTI) and diarrhoea are inappropriate [3]. As per International Medical Survey (IMS) Health data, units of antibiotics sold has increased by 40% in India from 2005 to 2009 [5], whereas in USA a 14% decrease in antibiotic usage was seen from 2002 to 2010 [6].

Doctors prescribe antibiotics to patients who do not need them and patients do not adhere to their treatment causing the risk of antibiotic resistance (many take antibiotics in under-dose or for shortened duration) [1-3]. Thus, it is also important to study the behaviour of the patients in order to understand the causes of overuse of these drugs. There is limited data regarding the behaviour of caregivers in respect to antibiotic use in the children, therefore, this study aims to explore the parental knowledge and practices regarding antibiotic use for children, and investigate the antibiotic prescription pattern in paediatric out-patient department of a secondary care government hospital of Gurgaon, Haryana, India.

Methods

A descriptive cross-sectional study was conducted in a secondary care government hospital of Gurgaon, Haryana over a period of one week (September 2013). The study targeted to interview the caregivers who accompanied the patients to the paediatric out-patient department of the hospital. The prescriptions were also analysed from the out-patient department to study the antibiotic prescription pattern and the rational use of antibiotics (as per National Formulary of India (NFI) guidelines) [7]. World Health Organization (WHO) guidelines [8] state that a minimum of 100 prescriptions should be analysed from one health facility and therefore a total of 100 prescriptions were analysed. Only new cases were included in the study and universal sampling method was followed. Similarly, 100 caregivers were interviewed face to face by the interviewer, using a pre-tested close-ended questionnaire. 

The questionnaire used to interview the caregivers contained sections on socio-demographic data, knowledge regarding antibiotics, and practices of caregivers regarding the course of treatment prescribed (antibiotics and other medicines). The questions had multiple choice options, with opportunity to choose more than one options in some questions. A proforma was used to collect the information from the prescriptions like signs and symptoms, antibiotic prescribed and laboratory investigations ordered. The research protocol was approved by the ethical committee. The interviewees were informed about the purpose and nature of the study in local language and the consents were obtained. Data was analysed using Epi Info 7 statistical software and univariate and bivariate analysis was performed. 

Results

Out of 100 prescriptions examined, 45% had antibiotics prescribed (two of the prescriptions had two antibiotics prescribed in each i.e. 47 antibiotics were prescribed. Of the 47 antibiotics prescribed, 41 (87%) were generic drugs, 44 (93%) were from the WHO Essential Drugs List (EDL) [9] and 34 (71%) were as per NFI guidelines. Out of the 45 prescriptions, 34 (76%) consisted of single antimicrobial agent, 9 (20%) were fixed-dose combinations and 2 (4%) were antimicrobial combinations (but not fixed-drug combinations).

Maximum antibiotics were prescribed for respiratory tract infections and fever cases. Cases like abdominal pain and diarrhoea also had antibiotics prescribed (Table 1). Amoxicillin (23/47, 49%) followed by Amoxicillin fixed-dose combinations (7/47, 15%) were the most commonly prescribed antibiotics (Table 1).



Of all the caregivers interviewed, 47 were males and 53 were females. 48 care-givers (males=32, females=16) were educated high school and above while 19 (males=3, females=16) were illiterates. 57 caregivers belonged to lower socio-economic class (males=17, females=40) while 43 belonged to middle class and above (males=30, females=13). Only 36 caregivers had knowledge of antibiotics- 21 males (45%) and 15 females (28%). All of them believed that antibiotics are used for the treatment of common cold and only 5 out of these 36 (14%) knew that antibiotics are used for bacterial infections (Table 2). Only 12 caregivers acknowledged that antibiotics have side-effects (33%) and only 3 (8%) agreed that misuse reduces their efficiency and increases antibiotic resistance. Knowledge of antibiotics was higher in caregivers educated till high school or above and belonging to middle class or above and it was significant (p<0.05) (Table 3). 59% parents completed the given course of treatment to their children; 23% stopped giving medicines after symptoms disappeared, 17% stopped few days after recovery and 1% after the medicines finished. In another question, majority of caregivers stated that they never changed medicines (93%) and dosage of medicines (82%) during given course of treatment. Most of the caregivers educated below high school (31/52, 60%) and belonging to middle class (33/57, 58%) completed the full course of treatment. No significant association was present between any demographic factors and the completion of full course of the treatment (Table 3).





Discussion

The proportion of antibiotic containing prescriptions i.e. 45% in the present study is quite similar to the results of other prescription analysis studies conducted in India [10-12] and neighbouring countries [3,13]. Most of the antibiotics prescribed in out-patient department were from the WHO EDL list and were generic drugs which is quite dissimilar to what was found in other studies [3,5,11,13]. This may be because the present study was conducted in a government hospital and the doctors are required to prescribe the drugs from the list of drugs available in hospital. 

The rational encounters of the present study were found to be similar to those in previous studies [5,10,11,14,15], but the results were dissimilar to WHO data which states that only 30% of prescriptions in public sector are in accordance with the guidelines in South Asia [3]. It was also found that there was a trend towards prescribing antibiotics for common ailments like respiratory tract infections and diarrhoea. Excessive use of antibiotics is similar to the results obtained from India [5,16] and other countries [3,13,14]. 

To understand the knowledge of antibiotics among the caregivers, a face to face interview was conducted outside the out-patients department. Overall the results of the study show that the participants had a poor knowledge of antibiotics when compared to the results of the other studies [4,17-19]. In terms of beliefs of antibiotic use, many of them believed that antibiotics are used for common cold, cough and viral fever. Only a few were aware that antibiotics are used for bacterial infections. Many studies have earlier demonstrated that misconceptions exist among the general public regarding the therapeutic effects of antibiotics. It is true that general public is not able to differentiate the types of causal agents of infectious diseases and often confuse the antibiotics with other symptomatic drugs, but when compared to other studies [4,17-19] these misconceptions were higher in the present study. Furthermore, the knowledge of side effects of antibiotics, most importantly antibiotic resistance was very low among the participants which is also in contrast to the results obtained in other studies [4,17,19,20] However, when lay people talk about ‘resistance’, this term could mean human resists to antibiotics rather than microorganisms to antibiotics. 

In the present study, association was present between education and socio-economic status of participant and knowledge of antibiotic. Similarly, education [17-19,20] and socio-economic status [19] were found to be associated with knowledge of antibiotics in other studies but some did find association with gender and age also [17-19,20].

Non-adherence to the given treatment is an important factor for the development of antibiotic resistance [1-3]. Therefore, compliance to the given course of treatment was assessed among the participants, irrespective of whether antibiotic was prescribed or not. It was noted that compliance was low and this finding was similar to other studies wherein less than 60% participants completed the course of treatment [18-20]. Incidentally, no association was found between any of the demographic factors and compliance to treatment. 

It can be concluded that though generic drugs and antibiotics from WHO EDL list are commonly prescribed in the paediatric out-patient department of the particular government hospital studied, but the rate of rational prescriptions is still low. Moreover, antibiotic knowledge among the caregivers is very low and this may lead to misuse of antibiotics among the population. The community as a whole need to be made aware of the antibiotics and its side-effects and the doctors need to be motivated to prescribe antibiotics rationally. Although, the results of this study cannot be extrapolated to the population at large, but do reflect the general tendency and the prevalent practices among care-givers.

References

1. Acharya AS. Have we reached a full circle? Time to ponder on antimicrobial resistance! World health day 2011: a public health perspective. Indian J Med Spec 2011;2:5-7.
2. Kashyap B. Combat drug resistance: no action today means no cure tomorrow. World health day 2011: a microbiologist’s perspective. Indian J Med Spec 2011;2:8-11.
3. Holloway A, Dijk LV. The world medicines situation 2011-Rational use of medicines. 3rd ed; 2011. http://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch14_wRational.pdf [Accessed on May 4, 2013] 
4. Rousounidis A, Papaevangelou V, Hadjipanayis A, Panagakou S, Theodoridou M, Syrogiannopoulos G, et al. Descriptive study on parents’ knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus. Int J Environ Res Public Health 2011;8:3246-62. [PUBMED]
5. Situation analysis antibiotic use and resistance in India. Global antibiotic resistance partnership- India national working group, March 2011. http://www.cddep.org/sites/cddep.org/files/publication_files/India-report-web.pdf  Accessed on June 19, 2013. 
6. Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D. Trends of outpatient prescription drug utilization in US children, 2002–2010. Pediatrics 2012;130:23–31. [PUBMED]
7. Anti-infectives. In: National Formulary of India. Ministry of Health and Family Welfare, India. 2011 4th edn, pp.105-234. http://www.cdsco.nic.in/NFI_2011.pdf Accessed on Sep 17, 2013.
8. How to investigate drug use in health facilities: selected drug use indicators. WHO publication, 1993. http://apps.who.int/medicinedocs/en/d/Js2289e/ Accessed on May 9, 2013.
9. WHO Model List of Essential Medicines. 18th List. April 2013, pp. 9-12 http://www.who.int/medicines/publications/essentialmedicines/en/index.html Accessed on July 21, 2013.
10. Amane H, Priyadarshini KOP. Prescription analysis to evaluate rational use of antimicrobials. Int J Pharm Bio Sci 2011;2:314-9. http://www.ijpbs.net/volume2/issue2/pharma/41.pdf Accessed on July 21, 2013.
11. Chattopadhyay A , Mondal T, Saha TK, Dey I, Sahu BK, Bhattacharya J. An audit of prescribing practices in CGHS dispensaries of Kolkata, India. IOSR-JDMS 2013;8:32-7. http://iosrjournals.org/iosr-jdms/papers/Vol8-issue1/G0813237.pdf Accessed on Dec 4, 2013.
12. Adiveni T, Chandra DS, Sundresh NJ,  Kumar BA, Padmini P,  Haritha K. Analysing the rationality of antibiotics in comparing the different departments in RMMCH. Journal of Biomedical and Pharmaceutical Research 2013;2:74-6. http://jbpr.in/index.php/jbpr/article/view/135/141 Accessed on Dec 4, 2013.
13. Ahmed SM, Islam QS. Availability and rational use of drugs in primary healthcare facilities following the national drug policy of 1982: Is Bangladesh on right track? J Health Popul Nutr 2012;30:99-108. [PUBMED]
14. Aldeyab MA, Kearney MP, McElnay JC, Magee FA, Conlon G, Gill D, et al. A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use. Br J Clin Pharmacol 2011;71:293–6. [PUBMED]
15. Ong DSY, Kuyvenhoven MM, Dijk LV, Verheij TJM. Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs. J Antimicrob Chemother 2008; 62:587–92. [PUBMED]
16. Kotwani A, Holloway K. Trends in antibiotic use among outpatients in New Delhi, India. BMC Infect Dis 2011;11:99. [PUBMED]
17. Widayati A, Suryawati S, Crespigny CD, Hiller JE. Knowledge and beliefs about antibiotics among people in Yogyakarta city Indonesia: a cross-sectional population-based survey. Antimicrob Resist Infect Control 2012;1:38. [PUBMED]
18. Parimi N, Pereira LMP, Prabhakar P. Caregivers’ practices, knowledge and beliefs of antibiotics in pediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study. BMC Fami Pract 2004;5:28. [PUBMED]
19. Oh AL, Hassali MA, Al-Haddad MS, Sulaiman SAS, Shafie AA, Awaisu A. Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia. J Infect Dev Ctries 2011;5:338-47. [PUBMED]
20. Kheder SI, Ayed IA. A survey of public knowledge and behavior related to antibiotic use and resistance in community pharmacies in Khartoum State. Int J Bioassays 2013;2(5).  ebioscholar.com/ojs/index.php/ijb/article/view/310 Accessed on Dec 4, 2013.
21. Jose J, Jimmy B, Al Sabahi AGMS, Al Sabie GA. A study assessing public knowledge, belief and behavior of antibiotic use in an Omani Population. Oman Med J 2013;28:324-30. [PUBMED]

buy clarithromycin usa

purchasing clarithromycin buy clarithromycin buy clarithromycin pills

biaxin buy

order clarithromycin 250mg biaxin buy cheap biaxin

order clarithromycin

buying clarithromycin buy clarithromycin buy biaxin australia

buy clarithromycin 250mg

clarithromycin online buy clarithromycin ordering clarithromycin

buy biaxin online

buy biaxin pills ordering biaxin order clarithromycin

buy generic biaxin

buy clarithromycin buy clarithromycin generic biaxin

buy biaxin 250mg

buy generic biaxin buy clarithromycin ordering biaxin

cheapest biaxin

clarithromycin buy clarithromycin biaxin buy

buy generic clarithromycin

buy biaxin canada buy clarithromycin clarithromycin reviews

on line abortion pill

online purchase abortion pill abortion pills abortion pills online

how to order the abortion pill online

buy abortion pill online pill for abortion online buy abortion pill

abortion pills online

where to buy abortion pill abortion pill on line abortion pill

buy abortion pills online

how to order the abortion pill online online purchase abortion pill order abortion pill

cytotec abortion

abortion pill buy online abortion pill buy the abortion pill online

buy viagra online inurl:nc

discount viagra viagra online female viagra

generic for kamagra

buy kamagra in great britain http://www.cengage.co.in/content/terms-of-use buy kamagra in london england

get kamagra jelly online

how does kamagra jelly work kamagra jelly female free sample kamagra jelly

buy cheap amoxil

female free sample amoxil amoxicillin photos amoxil

thyroxine samples

thyroxine samples buy thyroxine in great britain women does thyroxine work

generic bisacodyl

bisacodyl samples laxative generic bisacodyl online

free ampicillin sample

where to buy principen online http://www.cengage.co.in/content/competitive-examinations how to use ampicillin

buy abortion pill

where can i get the abortion pill online how to order the abortion pill online abortion pills

buy clarithromycin uk

buy biaxin http://www3.umu.se/kultmed/kurswebb/default.aspx?id=29 discount clarithromycin

fedex generic cipro

buy ciprofloxacin online cipro dosage mail order ciprofloxacin

clindamycin online

buy cleocin on the internet http://www.geospatialworld.net/Event/View.aspx?EID=62 buy cleocin online

mail order dexone

photos dexamethasone dexamethasone how does dexone work

buy Cefadroxil las vegas

natural Cefadroxil alternatives cefadroxil buy Cefadroxil

get cefpodoxime

vantin uk http://www.geospatialworld.net/Event/View.aspx?EID=151 get vantin online

cefuroxime online shop in uk

alternative to ceftin cefuroxime cheap cefuroxime

where to buy abortion pill

on line abortion pill abortion pill buy abortion pill online

get keflex online

cephalexin dosage http://www.fareastjournals.com/conf_detail.aspx?conf_id=5 buy keflex on the internet

buy cheap chloromycetin online uk

get chloramphenicol chloramphenicol photos chloramphenicol

order abortion pill online

abortion pill buy online medical abortion pill online buy abortion pill

clavulanate prescription

augmentin dosage augmentin how to use augmentin

order abortion pill

buy abortion pill http://www.centauricom.com/blog/blog/page/cheap-abortion-pill.aspx pill for abortion online


cheapest biaxin

order clarithromycin 500mg buy clarithromycin buy biaxin australia

purchase biaxin

buy clarithromycin 500mg buy clarithromycin purchase clarithromycin

cheap biaxin

buy biaxin uk clarithromycin reviews buy biaxin pills

buy discount clarithromycin

buy biaxin 250mg buy clarithromycin cheapest biaxin

purchase clarithromycin

purchase biaxin cheap biaxin buy biaxin no prescription

generic clarithromycin

clarithromycin online buy clarithromycin buy clarithromycin australia

order clarithromycin

clarithromycin reviews ordering biaxin biaxin reviews

order clarithromycin 500mg

order clarithromycin buy clarithromycin uk buy clarithromycin online

cheapest clarithromycin

purchase clarithromycin buy clarithromycin buy clarithromycin

buy cytotec for 24 week abortion

pill for abortion online http://www.cengage.co.in/content/about-us buy the abortion pill online

i need to buy the abortion pill

ordering abortion pills to be shipped to house abortion pill order abortion pill

medical abortion pill online

abortion pill online buy cytotec for 24 week abortion cytotec abortion

cytotec abortion pill buy online

order abortion pill online on line abortion pill i need to buy the abortion pill

abortion pill online purchase

abortion pill prescription abortion pill buy abortion pills online

women does viagra work

viagra reviews viagra pharmacy cheap viagra tablets

cialis vs kamagra

alternative to kamagra http://www.cengage.co.in/content/terms-of-use kamagra canada

kamagra jelly jokes

buy kamagra jelly online safe kamagra jelly kamagra jelly jokes

cialis vs amoxicillin

get amoxil amoxicillin amoxil equivalent

buy cheap thyroxine online uk

synthroid prescription synthroid women does synthroid work

get discount laxative online

free bisacodyl sample buy laxative on the internet get discount bisacodyl online

fedex generic principen

buy ampicillin online ampicillin natural principen alternatives

how to order the abortion pill online

buy abortion pills online http://www3.umu.se/kultmed/kurswebb/default.aspx?id=1 cytotec abortion

cheapest biaxin

buy cheap biaxin http://www3.umu.se/kultmed/kurswebb/default.aspx?id=29 order clarithromycin 250mg

natural cipro

buy cipro online http://www.geospatialworld.net/Event/View.aspx?EID=37 buy ciprofloxacin online a href

fedex generic clindamycin

mail order clindamycin clindamycin photos clindamycin

dexamethasone equivalent

buy dexamethasone online free dexamethasone sample buy dexamethasone online a href

female herbal Cefadroxil

female herbal duricef cefadroxil Cefadroxil prescription buy

generic cefpodoxime online

how does vantin work cefpodoxime mail order cefpodoxime

free ceftin sample

buy cefuroxime online a href http://www.geospatialworld.net/Event/View.aspx?EID=154 ceftin prescription

where can you buy the abortion pill

how to order the abortion pill online medical abortion pill online on line abortion pill

how does cephalexin work

purchase cephalexin online free keflex sample get cephalexin avoid prescription

female herbal chloromycetin

buy chloromycetin las vegas chloromycetin for sale chloromycetin prescription

cytotec abortion

buy the abortion pill online http://www.fareastjournals.com/journal_detail.aspx?jid=18 abortion pill prescription

female herbal augmentin

purchase clavulanate online alternative to augmentin how does clavulanate work

cytotec abortion

where to buy abortion pills online i need to buy the abortion pill abortion pill buy online