Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study.

BACKGROUND: To date, outcome data with a large sample size and data regarding the clinical outcomes of pharmacokinetic-guided (PK) dosing of vancomycin are limited. AIM: We evaluated the pharmacokinetic and clinical outcomes of a PK-guided dosing advisory program, pharmacokinetic consultation service (PKCS), in vancomycin treatment. METHODS: We investigated vancomycin therapeutic drug monitoring (TDM) and PKCS use through a retrospective review of patients who had serum vancomycin trough concentration data from October 2017 to November 2018. Among these patients, we selected non-critically ill adult patients satisfying our selection criteria to evaluate the effect of PKCS. Target trough attainment rate, time to target attainment, vancomycin-induced nephrotoxicity (VIN), vancomycin treatment failure rate, and duration of vancomycin therapy were compared between patients whose dosing was adjusted according to PKCS (PKCS group), and those whose dose was adjusted at the discretion of the attending physician (non-PKCS group). RESULTS: A total of 280 patients met the selection criteria for the VIN analysis (PKCS, n=134; non-PKCS, n=146). The incidence of VIN was similar between the two groups (PKCS, n=5; non-PKCS, n=5); however, the target attainment rate was higher in the PKCS group (75% vs 60%, P = 0.012). The time to target attainment was similar between the two groups. Further exclusions yielded 112 patients for the clinical outcome evaluation (PKCS, n=51; non-PKCS, n=61). The treatment failure rate was similar, and the duration of vancomycin therapy was longer in the PKCS group (12 vs 8 days, P = 0.008). CONCLUSION: In non-critically ill patients, an increase in target trough achieved by PKCS did not lead to decreased vancomycin treatment failures, shorter vancomycin treatment, or decreased nephrotoxicity in vancomycin treatment. Considering the excessive amount of effort currently put into vancomycin dosing and monitoring, more selective criteria for individualized pharmacokinetic-guided dosing needs to be applied.

In vitro and in vivo hypoglycemic effects of cyanidin 3-caffeoyl-p-hydroxybenzoylsophoroside-5-glucoside, an anthocyanin isolated from purple-fleshed sweet potato.

Anthocyanins are major components of purple sweet potatoes (PSP) with antioxidant, anti-obesity, and antidiabetic activity. In this study, we evaluated the hypoglycemic effects of 12 individual anthocyanins purified from PSP (Korean variety Shinzami). We separated the anthocyanins using liquid chromatography with diode array detection and electrospray ionization/mass spectrometry (LC-DAD-ESI/MS). Three anthocyanins were selected through a radical scavenging activity test. We examined whether individual anthocyanins inhibited glucose secretion in HepG2 cells (hepatic gluconeogenesis). Additionally, we determined the effect of each anthocyanin on fasting blood glucose levels in 6-week-old male C57BL/6J mice fed a 60% high-fat diet for 14 weeks. Mice were evaluated at 0, 1, 2, and 4 h after oral administration of anthocyanins (80 mg/kg), an anthocyanin-rich-fraction (80 mg/kg), positive control (metformin, 80 mg/kg), and distilled water (control). Cyanidin 3-caffeoyl-p-hydroxybenzoylsophoroside-5-glucoside (PEAK9) was the main PSP anthocyanin that inhibited hepatic glucose secretion and reduced blood glucose.