• From each patient's medical records, we collected information about demographics and concurrent illness, antimicrobial drug history, history of prior MRSA and vancomycin-resistant Enterococcus spp. (cdc.gov)
  • Vancomycin Resistant Enterococcus cultures are tested daily, Monday to Friday. (publichealthontario.ca)
  • These reports include data for Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremias and vancomycin-resistant enterococcus (VRE) bacteremias. (publichealthontario.ca)
  • Zyvox (linezolid) has received Federal Drug Administration approval for treatment of Vancomycin Resistant Enterococcus (VRE) infections, nosocomial pneumonia, community-acquired pneumonia, and various skin/skin structure infections. (ny.gov)
  • The emergence of antimicrobial-resistant microbes (e.g., healthcare-acquired and community-acquired methicillin-resistant Staphylococcus aureus[MRSA], vancomycin-resistant Enterococcus[VRE] and multidrug-resistant Gram-negative bacilli), along with growing concern regarding the spread of Clostridia difficile bacteria are problems facing all healthcare providers. (crimescenerestoration.com)
  • Vancomycin-resistant Staphylococcus aureus (VRSA) infections, which are always methicillin-resistant, are a rare but serious public health concern. (cdc.gov)
  • Vancomycin continues to be used as a first-line antimicrobial agent for the treatment of infection with methicillin-resistant Staphylococcus aureus (MRSA). (cdc.gov)
  • Vancomycin-resistant Staphylococcus aureus (VRSA) culture, treatment, and period of potential transmissibility timelines, 2 patients, February 2007-April 2008. (cdc.gov)
  • Vancomycin, a glycopeptide antibacterial agent, has tremendous potential to significantly reduce the incidence and severity of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive beta-lactam-resistant bacteria over the past 50 years ( Morales-Alvarez, 2020 ). (frontiersin.org)
  • Staphylococcus aureus is one of the most common causes of both hospital- and community-acquired infections worldwide, and the antimicrobial agent vancomycin has been used to treat many S. aureus infections, particularly those caused by methicillin-resistant S. aureus (MRSA). (cdc.gov)
  • This report describes the first isolation of VISA from a patient in the United States, which may be an early warning that S. aureus strains with full resistance to vancomycin will emerge. (cdc.gov)
  • Editorial Note: Since the 1980s, when MRSA emerged in the United States, vancomycin has been the last uniformly effective antimicrobial available for treatment of serious S. aureus infections. (cdc.gov)
  • This report documents the emergence of VISA in the United States and may signal the eventual emergence of S. aureus strains with full resistance to vancomycin. (cdc.gov)
  • Detailed recommendations for the prevention, detection, and control of S. aureus strains with reduced susceptibility to vancomycin are outlined in 'Interim Guidelines for Prevention and Control of Staphylococcal Infection Associated with Reduced Susceptibility to Vancomycin,' published previously in MMWR (4). (cdc.gov)
  • Intermediate or resistance of the S. aureus isolate to vancomycin, detected and defined according to Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) approved standards and recommendations (Minimum Inhibitory Concentration [MIC]=4-8 µg/ml for VISA and MIC≥16 µg/ml for VRSA). (cdc.gov)
  • A case of vancomycin-intermediate or vancomycin-resistant S. aureus that is laboratory-confirmed (MIC=4-8 µg/ml for VISA and MIC≥16 µg/ml for VRSA). (cdc.gov)
  • There have been no reported cases of vancomycin-resistant Staphylococcus aureus (VRSA) in Alaska. (alaska.gov)
  • Staphylococcus aureus , a commensal of human skin and mucosae is the second most common pathogen responsible for health-care associated infections (HAIs) in newborn that accounts for high morbidity, mortality, and healthcare-associated costs [1]. (fortunepublish.com)
  • Vancomycin Resistant Staphylo-coccus Aureus (VRSA) is also an emerging problem in health care associated infections in hospital. (fortunepublish.com)
  • This has lead to a staggering increase in antibiotic resistant infections, such as methicillin-resistant Staphylococcus aureus ( MRSA ) and vancomycin-resistant enterococci ( VRE ). (diseasedaily.org)
  • Over the past 4 decades, epidemiologic tendencies have shown an escalation not only in healthcare-associated methicillin-resistant S aureus (HA-MRSA) but also in community-associated MRSA (CA-MRSA). (medscape.com)
  • This makes healthcare providers reliant on other antibiotics. (cdc.gov)
  • Vancomycin is an antibiotic that is used to treat severe infections that are resistant to certain other antibiotics. (uofmhealth.org)
  • Vancomycin injection is in a class of medications called glycopeptide antibiotics. (medlineplus.gov)
  • Antibiotics such as vancomycin injection will not work for colds, flu, or other viral infections. (medlineplus.gov)
  • If you stop using vancomycin injection too soon or skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics. (medlineplus.gov)
  • Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. (kaiserpermanente.org)
  • Vancomycin-resistant enterococci infections are treated with antibiotics, which are the types of medicines normally used to kill bacteria. (kaiserpermanente.org)
  • But they do know that VRE infections are more likely to develop when antibiotics such as vancomycin are used often. (kaiserpermanente.org)
  • If you contract a C. diff infection while taking antibiotics for another infection, and the illness is mild, your healthcare provider may recommend that you simply stop the medication. (healthcarenewshubb.com)
  • Healthcare-associated infections can lead to the need for stronger or more antibiotics, more treatments, more days in the hospital, more cost for the patient and the hospital, and even severe complications or death. (oregon.gov)
  • [ 6 , 7 ] Health care providers prescribed 262.5 million courses of antibiotics in 2011 (842 prescriptions per 1000 persons), and prescriptions per 1,000 persons vary markedly according to geography. (medscape.com)
  • This involves educating both healthcare providers and patients on the illnesses antibiotics are supposed to treat, the prescription of proper doses, and the importance of completing the full prescription. (diseasedaily.org)
  • A healthcare provider also asks about the person's symptoms, medical history, and use of antibiotics. (healthcheckup.com)
  • If you take antibiotics, ask about a probiotic and notify your health care provider immediately if you are having diarrhea. (cancer.org)
  • Enterococci, a type of bacteria, can cause serious infections for patients in healthcare settings, including bloodstream, surgical site, and urinary tract infections. (cdc.gov)
  • Widespread use of antimicrobials, such as vancomycin, is a major contributing factor for the emergence of vancomycin-resistant organisms, including vancomycin-resistant enterococci. (cdc.gov)
  • Further, this strain of enterococci has developed the clever ability to pass its resistance to vancomycin on to other, unrelated bacteria - such as MRSA. (diseasedaily.org)
  • Vancomycin injection is used alone or in combination with other medications to treat certain serious infections such as endocarditis (infection of the heart lining and valves), peritonitis (inflammation of the lining of the abdomen), and infections of the lungs, skin, blood, and bones. (medlineplus.gov)
  • Vancomycin injection comes as a powder to be added to fluid and injected intravenously (into a vein). (medlineplus.gov)
  • You may experience a reaction while you receive a dose of vancomycin injection, usually during your infusion or soon after your infusion has completed. (medlineplus.gov)
  • Tell your doctor immediately if you experience any of these symptoms while you receive vancomycin injection: dizziness, wheezing, shortness of breath, itching, hives, flushing of the upper body, or muscle pain or spasm of the chest and back. (medlineplus.gov)
  • You may receive vancomycin injection in a hospital or you may use the medication at home. (medlineplus.gov)
  • If you are using vancomycin injection at home, use it at around the same time every day. (medlineplus.gov)
  • Use vancomycin injection exactly as directed. (medlineplus.gov)
  • If you will be using vancomycin injection at home, your healthcare provider will show you how to infuse the medication. (medlineplus.gov)
  • Ask your healthcare provider what to do if you have any problems infusing vancomycin injection. (medlineplus.gov)
  • You should begin feeling better during the first few days of your treatment with vancomycin injection. (medlineplus.gov)
  • Use vancomycin injection until you finish the prescription, even if you feel better. (medlineplus.gov)
  • Vancomycin injection may also be given orally to treat colitis (inflammation of the intestine caused by certain bacteria) that may occur after antibiotic treatment. (medlineplus.gov)
  • tell your doctor and pharmacist if you are allergic to vancomycin, any other medications, or any of the ingredients in vancomycin injection. (medlineplus.gov)
  • If you become pregnant while using vancomycin injection, call your doctor. (medlineplus.gov)
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving vancomycin injection. (medlineplus.gov)
  • Last week, the FDA approved the addition of a severe vision loss warning in the FDA-approved labels of injectable vancomycin, but since labels for compounded drugs are not reviewed or approved by the FDA, this warning will not necessarily be included in the labels of compounded drugs with vancomycin for injection. (outbreaknewstoday.com)
  • Today, the FDA issued a Compounding Risk Alert concerning an adverse event associated with compounded triamcinolone, moxifloxacin and vancomycin (TMV) for intraocular injection. (outbreaknewstoday.com)
  • On Sept. 28, 2017, the agency approved a supplemental new drug application that adds a subsection about HORV to the WARNINGS section of the prescribing information in the labeling of the FDA approved Vancomycin Injection, USP. (outbreaknewstoday.com)
  • The US Injectable business also performed well, with 23% year-on-year revenue growth, attributed to our focus on VANCO READY® Vancomycin Injection, USP and the launch of new products. (xellia.com)
  • During January 1996-June 1997, the patient had been treated with multiple courses of both intraperitoneal and intravenous vancomycin for repeated episodes of MRSA-associated peritonitis. (cdc.gov)
  • The combination of intravenous vancomycin and piperacillin/tazobactam (TZP) was associated with an increased risk of acute kidney injury (AKI) in children, researchers reported. (medpagetoday.com)
  • Based on the results of this study, when combination therapy with intravenous vancomycin and TZP in particular is clinically indicated in a hospitalized child, clinicians should closely monitor the patient's kidney function and limit the patient's exposure to this combination therapy if at all possible. (medpagetoday.com)
  • The researchers performed multiple logistic regression analysis to test the association between AKI and receipt of intravenous vancomycin plus TZP or vancomycin plus one other antipseudomonal β-lactam antibiotic. (medpagetoday.com)
  • A recent evaluation of prescribing for inpatients in two specific scenarios (urinary tract infections in patients without indwelling catheters and treatment with intravenous vancomycin) identified that antibiotic use could have been improved in 37% of cases. (medscape.com)
  • Report the use of other drugs which might be potentially toxic to the kidney such as: aminoglycosides (e.g., gentamicin, amikacin), amphotericin B, cyclosporine, non-steroidal anti-inflammatory drugs (e.g., ibuprofen), tacrolimus, vancomycin. (patientassistance.com)
  • Continued infection control and appropriate antibiotic use are infections are resistant to vancomycin, reducing important to maintain decreases in VRE infections. (cdc.gov)
  • Certain multi-drug resistant organisms are conditions reportable by state regulations (7 AAC 27.005 and .007) by healthcare providers and laboratories to the Alaska Section of Epidemiology (see below. (alaska.gov)
  • Additionally, infections with antibiotic-resistant organisms 'of national importance' must be reported by healthcare providers and laboratories according to state regulations (7 AAC 27.005 and .007). (alaska.gov)
  • If women do not improve and do not have an abscess, vancomycin 1 g IV every 12 hours or cefotetan 1 to 2 g IV every 12 hours to cover resistant organisms should be considered. (msdmanuals.com)
  • Vancomycin will not treat a viral infection such as the flu or a common cold. (uofmhealth.org)
  • The C diff Foundation hosts a 24-hour hotline to support patients, families, and health care providers through the difficulties of a C. diff infection (1-844-FOR-CDIF). (cdc.gov)
  • Personal Protective Equipment (PPE): During the care of a patient diagnosed with a C. diff infection, following infection-control policies, healthcare and environmental service professionals are to wear PPE to minimize exposure to serious workplace illnesses (acute care, long-term care, and home care environments). (cdc.gov)
  • Communication: Contacting and alerting other healthcare facilities, prior to transferring a patient, to report an active C. diff infection to implement and follow contact precautions and isolation policies. (cdc.gov)
  • We host regular webinars on infection prevention topics through the State Contact Nursing Hour Provider Unit. (alaska.gov)
  • The HAI Program staff are also always available to healthcare providers and the public to answer questions about infection prevention and to address concerns about healthcare-associated infections. (alaska.gov)
  • C. difficile infection (CDI) is one of the most common healthcare-associated infections (HAI) identified in hospitals in the United States. (ca.gov)
  • What is a healthcare-associated infection (HAI)? (oregon.gov)
  • A healthcare-associated infection, or HAI, is an infection that a patient gets while having healthcare for another reason. (oregon.gov)
  • Infection preventionists in healthcare systems are always on the lookout for ways to prevent HAIs. (oregon.gov)
  • Infection with VRE occurs almost exclusively in healthcare facilities, and is also transmitted through direct contact with the microbe. (diseasedaily.org)
  • Recommended antibiotic regimens for treatment of intraamniotic infection are ampicillin and gentamicin , cefazolin and gentamicin, or clindamycin or vancomycin and gentamicin. (medscape.com)
  • Isolates were submitted to the Centers for Disease Control and Prevention (CDC) for PCR testing for van genes, which encode vancomycin resistance, and for genetic analysis by pulsed-field gel electrophoresis (PFGE) and plasmid restriction digest to compare with other VRSA isolates ( 5 - 7 ). (cdc.gov)
  • Clostridioides difficile (C. difficile) is a spore-forming, toxin-producing bacteria that causes diarrheal disease, most commonly in patients with recent healthcare exposure and antibiotic use. (ca.gov)
  • Because alternative treatments are limited, development of resistance to vancomycin can make treatment of MRSA infections increasingly difficult. (cdc.gov)
  • Because of challenges in maintaining therapeutic levels (trough levels of 5-12 mcg/ml) in the severely ill and an evolving pattern of resistance, vancomycin is no longer the author's "go to" choice. (medscape.com)
  • Vancomycin has been the traditional drug to administer to those with severe beta-lactam allergies and as treatment of CoNS and MRSA. (medscape.com)
  • Others may need a treatment course with a new antibiotic (metronidazole or vancomycin). (carle.org)
  • 40,000 bloodstream infections (CLABSIs), according to CDC's National Healthcare Safety Network. (cdc.gov)
  • The HAI Program collects data about HAIs using the National Healthcare Safety Network (NHSN). (alaska.gov)
  • All California acute care hospitals are required to report healthcare facility-onset CDI to CDPH via the National Healthcare Safety Network. (ca.gov)
  • These include the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Healthcare Safety Network, claims data from health plans and insurance companies, and data from private vendors. (medscape.com)
  • These multi-center, randomized, double-blind trials enrolled a total of 1,164 adults with confirmed CDI, who received either DIFICID (200 mg q12h) or vancomycin (125 mg q6h), the only FDA-approved product for the treatment of CDI. (prnewswire.com)
  • Vancomycin is an important antibiotic for treatment of gram-positive infections, but clinicians need to be cognizant of its potential for nephrotoxicity. (medpagetoday.com)
  • The mechanism by which TZP and vancomycin cause greater nephrotoxicity is unknown. (medpagetoday.com)
  • Vancomycin may also be used for purposes not listed in this medication guide. (uofmhealth.org)
  • A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself. (uofmhealth.org)
  • The basic clinical information, vancomycin dosage and days, comorbidities and medication, laboratory indicators of the patients were recorded. (frontiersin.org)
  • Patients who have been prescribed Metformin that expires within the above-noted date range should reach out to their medical provider to determine if their batch is part of the recall, and to obtain replacement medication if needed. (pharmacyerrorinjurylawyer.com)
  • In addition, DIFICID met the primary endpoint of non-inferiority of clinical cure (defined as patients requiring no further CDI therapy two days after completion of study medication) compared to vancomycin. (prnewswire.com)
  • Continuing to expand the institutional customer base and growing penetration with existing customers are key components of the VANCO READY® strategy, and 2022 demonstrated that healthcare providers are showing a preference for premixes as they aid in promoting safe medication administration practices and timeliness to treat patients. (xellia.com)
  • Patient with vancomycin order. (childrensmercy.org)
  • To develop a list of potential patient contacts, we assessed healthcare visits, community activities, and personal acquaintances from this period. (cdc.gov)
  • Stratified analysis of the comorbidities in patients with vancomycin-associated AKI further confirmed the necessity for different patient populations to be studied. (frontiersin.org)
  • The FDA received an adverse event report on Aug. 14, 2017, from a physician concerning a patient who was diagnosed postoperatively with bilateral hemorrhagic occlusive retinal vasculitis (HORV), which is a rare, potentially blinding postoperative complication that has been observed in dozens of patients who have received intraocular injections of vancomycin (anti-infective) formulations toward the end of otherwise uncomplicated cataract surgeries. (outbreaknewstoday.com)
  • What can I do as a patient to prevent healthcare-associated infections? (oregon.gov)
  • Healthcare providers should never reuse a needle or syringe on more than one patient. (oregon.gov)
  • All-cause mortality at 90 days after platform entry determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries. (who.int)
  • In this setting, signs and symptoms that alert the provider to a potential problem and that are apparent under other circumstances are often missing, as a consequence of the absence of an alert and communicative patient. (medscape.com)
  • however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. (bvsalud.org)
  • Vancomycin is also used to treat serious infections in people who are allergic to penicillin. (uofmhealth.org)
  • When serious infections are suspected, vancomycin and a β-lactam agent are often coadministered to provide appropriate empirical broad-spectrum coverage until a pathogen is identified. (medpagetoday.com)
  • Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient's health needs. (cdc.gov)
  • In Phase 3 clinical studies, DIFICID was proven to be as effective as vancomycin in clinical cure, and was superior to vancomycin in global cure, defined as cure without a recurrence after 4 weeks of therapy. (prnewswire.com)
  • The AIDAC based its decision in part on the review of clinical evidence from the two largest, comparative Phase 3 clinical trials ever conducted against vancomycin in CDI. (prnewswire.com)
  • In both studies, DIFICID demonstrated a statistically significant reduction in the rate of recurrence compared with patients treated with vancomycin, reducing CDI recurrences by 47 percent, and was statistically superior to vancomycin in global cure rate (clinical cure without disease recurrence within four weeks). (prnewswire.com)
  • [ 6 ] An accurate assessment of antibiotic prescribing, regardless of clinical setting, is important to identify opportunities to improve prescribing and maintain provider accountability. (medscape.com)
  • Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. (bvsalud.org)
  • By presenting three cases we aim to give healthcare providers more insight into the clinical scenario of non-union. (bvsalud.org)
  • Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. (uofmhealth.org)
  • Tell your health care providers about all medicines taken. (cigna.com)
  • Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. (chemocare.com)
  • Ask your health care provider if Dramamine may interact with other medicines that you take. (thecityclub.in)
  • There were significant decreases in hospital- and those who are undergoing complex or prolonged community-onset VRE cases--around 30,400 fewer cases healthcare (such as patients in long-term acute in 2017 compared to 2012. (cdc.gov)
  • Vancomycin-associated acute kidney injury (AKI) continues to pose a major challenge to both patients and healthcare providers. (frontiersin.org)
  • However, the treatment window for vancomycin was narrow and individual differences were considerable. (frontiersin.org)
  • We are proud to be one step closer to providing patients, healthcare providers and physicians with a new treatment option for CDI, a serious and debilitating disease that can impact every aspect of a patient's life. (prnewswire.com)
  • The objective of both studies was to show that a 10-day course of DIFICID was at least as efficacious (non-inferior) and safe as a 10-day course of vancomycin for the treatment of CDI. (prnewswire.com)
  • DIFICID was safe and well tolerated in both studies, showing a similar incidence of treatment-related adverse events when compared to vancomycin. (prnewswire.com)
  • Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts. (medscape.com)
  • Timely maternal management together with notification of the neonatal health care providers will facilitate appropriate evaluation and empiric antibiotic treatment when indicated," the opinion concludes. (medscape.com)
  • ask your health care provider or pharmacist if you have questions. (chemocare.com)
  • The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. (patientassistance.com)
  • Contact your healthcare provider for a replacement dose. (cigna.com)
  • Check with your health care provider before you start, stop, or change the dose of any medicine. (thecityclub.in)
  • If you miss a dose, contact your health care provider to determine a new schedule if necessary. (patientassistance.com)
  • Vancomycin is given as an infusion into a vein, over at least 60 minutes. (uofmhealth.org)
  • The FDA intends to use compounding risk alerts to communicate safety issues linked to compounded drugs to health care providers to help inform decisions about the medications they administer. (outbreaknewstoday.com)
  • Machine learning algorithm of XGBoost was used to construct a series risk prediction model for vancomycin-associated AKI in different underlying diseases. (frontiersin.org)
  • As the results of the analysis showed that in addition to the common indicators (serum creatinine and creatinine clearance rate), some other underappreciated indicators such as serum cystatin and cumulative days of vancomycin administration, weight and age, neutrophils and hemoglobin were the risk factors for cancer, diabetes mellitus, heptic insufficiency respectively. (frontiersin.org)
  • Understanding how the nephrotoxic potential of vancomycin is altered by the choice of β-lactam agent can inform empirical antibiotic decisions that will reduce the risk for subsequent AKI. (medpagetoday.com)
  • bacterial spores are all around in the environment, including healthcare settings, non-healthcare settings and even on the soles of shoes . (healthcarenewshubb.com)
  • Community-onset infections include infections in patients with recent healthcare exposure and infections in people without prior healthcare exposure. (cdc.gov)
  • Health care providers are required to make these recommendations to cases, suspected cases and contacts. (hawaii.gov)
  • Tell all of your health care providers that you take this drug. (optum.com)
  • Therefore, health care providers administering eye injections of compounded drugs containing vancomycin for prophylaxis may not be immediately aware of this potentially blinding postoperative complication associated with its use. (outbreaknewstoday.com)
  • DO make sure that your health care providers use disposable gloves, gowns, and proper washing methods before caring for you. (carle.org)
  • Tell your doctor if you feel any burning, pain, or swelling around the IV needle when vancomycin is injected. (uofmhealth.org)
  • In settings where TZP and vancomycin are both needed, clinicians should make efforts to limit the duration of combination therapy. (medpagetoday.com)
  • The opinion also highlights the critical need for clinician communication between the maternal and neonatal healthcare teams. (medscape.com)
  • Use Dramamine exactly as directed by your Health Provider. (thecityclub.in)
  • What are the possible side effects of vancomycin? (uofmhealth.org)
  • If you get any side effects, talk to your health care provider.This includes unwanted effects not listed in this leaflet. (who.int)
  • If you might have queries about side effects, contact your health care provider. (drugmedsgroup.top)
  • Our study is a retrospective analysis of medical records of 724 patients who have received vancomycin therapy from 1 January 2015 through 30 September 2020. (frontiersin.org)
  • Be aware of CDI incidence in healthcare facilities and communities. (ca.gov)
  • Just today, the FDA provided details about a case of severe vision loss associated with eye injections of a compounded drug containing vancomycin. (outbreaknewstoday.com)
  • If you have an allergy to vancomycin or any other part of this drug. (optum.com)
  • Of Xellia's own in-house products, the focus has been on the sale of Xellia's VANCO READY®, ready-to-use vancomycin drug product. (xellia.com)
  • Consult your healthcare professional before using this drug. (patientassistance.com)
  • Public health and healthcare providers should coordinate efforts to address CDI prevention across the continuum of healthcare. (ca.gov)
  • Ask your health care provider questions you could have about how to make use of Dramamine. (drugmedsgroup.top)