Earticle

This research is conducted to evaluate the clinical and economic benefits from therapeutic drug monitoring(TDM) service on vancomycin in a tertiary general hospital. Total 99 pairs of steady state peak and trough concentrations of vancomycin were obtained from 73 patients. To see the clinical benefits, the appropriateness of vancomycin dosing before TDM was evaluated. In 72 pairs of vancomycin blood concentrations obtained prior to TDM consultation, of the cases had reached within therapeutic range. Serum vancomycin levels in patients with $40{\leq}CLcr<60$ (ml/min) were higher and than the levels in patients with 40>CLcr and (ml/min). Dose reduction rate in patients with creatinine clearance $40{\leq}CLcr<60$ (ml/min) were also significantly higher than those of compared groups (, p=0.0138). Serum vancomycin concentrations were re-obtained from 21 patients who received modified dose through TDM service. Ninety percent (19/21cases) of them were within the target therapeutic range. For the evaluation of economic benefits from TDM consultation, estimated cost savings were calculated in those patients. The total drug saving were 586 vials in 21 patients. The calculated mean cost saving from the drugs was 314,570 won (range: per patient. The study revealed that TDM service for vancomycin is necessary because empirical dosing is not effective for obtaining therapeutic drug level, especially patients with mild renal insufficiencies. The cost saving from TDM is also beneficial for the patients.

Cilostazol has both antithrombotic and cerebral vasodilating effects, and one of the mechanism is the selective inhibition of platalet cyclic AMP phosphodiesterase. Bioequivalence of two cilostazol tablets, the (Korea Otsuka Pharmaceutical Co.) and the LG (LG Chemical Co.), was evaluated according to the guidelines of Korea Food and Drug Administration (KFDA). Sixteen normal male volunteers ( years old) were randomly divided into two groups and a randomized cross-over study was employed. After oral administration of or LG tablet (100 mg cilostazol), blood samples were taken at predetermined time intervals and the serum cilostazol concentrations were determined using an HPLC method with UV/VIS detector. The pharmacokinetic parameters were calculated and ANOVA was utilized for the statistical analysis. The results showed that the differences in AUCt, C_{max} and Tmax between two tablets based on the tablet were , respectively. The powers (1-) for , respectively. Minimum detectable differences () and confidence intervals were all less than . All these parameters met the criteria of KFDA for bioequivalence, indicating that LG tablet is bioequivalent to tablet.

Omeprazole is usually administered as encapsulated enteric-coated granules and enteric-coated tablets because of its acid-labile nature. For children and patients who can not swallow, it can be mixed with water or other liquid after a capsule is opened or a tablet is crushed. This study was performed to compare omeprazole liquid formulations of tablet and capsule Omeprazole 20 mg capsule containing enteric coated granules was opened and 20 mg entric-coated tablet was ground to be mixed with sodium bicarbonate solution, orange juice or water. Each liquid formulation was poured into dissolution tester, mixed with first solution (artificial gastric juice; pH 1.2) for two hours, then with second solution (artifical enteric juice; pH 6.8) for thirty minutes. pH was measured periodically for two and half hours. Samples were drawn periodically, mixed with lansoprazole as an internal standard, and injected to HPLC. As results, pH of sodium bicarbonate solution of omeprazole was significantly higher than that of orange juice or water in first solution (6.2-7.4 vs. 1.2, p<0.005). At 150 min, concentrations of omeprazole in three diluents with granules and in sodium bicarbonate solution of tablet powder sustained significantly higher than in other solution of tablet powder (p<0.001). In conclusion, enteric-coated granules from capsule with three diluents and powder from tablet in sodium bicarbonate solution was stable during dissolution test, which would be appropriate and recommended for patient who can not swallow solid preparations.

Teicoplanin, a glycopeptide antibiotic, has potential for use as an alternative to vancomycin in the treatment of gram-positive bacterial infections. However, unlike vancomycin, there is a lack of study on teicoplanin's efficacy and safety and the guideline for its use is not available, yet. The objective of this study was to investigate and evaluate the pattern of teicoplanin usage in a university hospital. A retrospective study was performed on 72 adult patients, who took teicoplanin for 3 continuous days at D. University hospital from 1 January 1999 to 30 June 2000. The microorganisms treated with teicoplanin were methicillin-resistant Staphylocorcus aureus , coagulase-negative Staphylococci , Enterococcus , vancomycin-resistant Enterococci , Streptococci , and Bacillus . The types of infection treated with teicoplanin were surgical wound infection , lower respiratory infection , bactremia , urinary tract infection , pleural fluid infection , and peritoneal fluid infection . The mean duration of teicoplanin usage was 16.5 days and teicoplanin was used with 1.4 other antibiotics, which were aminoglycosides (isepamicin, amikacin, netilmicin, astromicin) or quinolones (ciprofloxacin, tosufloxacin) or the third generation cephalosporin (ceftazidime). Only 24 cases met with the criteria for the justification of use, and the rest of 60 cases did not meet the criteria. In 84 cases , blood culture tests were performed prior to the initial dose of teicoplanin. In 83 cases , serum creatinine were conducted before the initial doses. In 45 cases , serum creatinine was monitored at least twice weekly. In 55 cases , WBC was tested at least twice weekly. In 84 cases , body temperature was monitored at least once per nursing shift. In 15 cases out of 56 cases, maximum temperature decreased at least 1 degree within 3 days of teicoplanin use. In 15 case out of 35 cases, WBC values were within the normal range after treatment. In 23 cases , dosage regimen was appropriate. Drug-related adverse effects were reported in 13 cases. Nephrotoxicity (progressively increasing SCr. or sustained SCr increase of 0.5 mg/dl from baseline) was noted in five cases. Neutropenia (absolute neutrophil count <1,500 ) was noted in one case and eosinophilia (total eosinophil count >350 ) was noted in seven cases. A more strict control on use of teicoplanin is required, considering that teicoplanin is categorized as one of restricted antibiotics.

Recently, the use of electronic drug information databases has been increased alternative to printed references. However, databases vary widely in quality and quantity of drug information provided and many questions have arisen about their accuracy, completeness, and reliability. This study was designed to compare and evaluate the drug information contained in four Korean drug information databases which are available on CD-ROM and internet. Four Korean drug information databases selected to be evaluated were eKIMS, Datapower, KPA Standard Drug Information and Korean Drug Formulary. Databases were searched and evaluated from August 10 to September 30, 2000 by the same trained searcher to minimize the bias. The database evaluation form was developed for objective evaluation of each databases in terms of credibility of database, convenience of use and other characteristics. The second form was developed for quantitative and qualitative assessment of the drug information provided by the databases. The results of the study showed that there were no significant differences in 4 databases in terms of convenience of use and other characteristics. However, for credibility of databases, Korean Drug Formulary was significantly superior to all other databases (P<0.05). It showed that information provided by Korean Drug Formulary was the best in terms of pharmacokinetics, chemistry, comparisons and eKIMS was the best in terms of drug identification (P<0.05). For accuracy and completeness of information provided, the study could not find a significant difference between 4 databases (P>0.05).