Diuretic Effects of Roselle (Hibiscus Sabdariffa) – Stevia (Stevia Rebaudiana) Tea Compared with Hydrochlorothiazide in Diabetic Patients with Hypertension

Objective: To compare diuretic effects of Roselle-Stevia (R-S) tea withhydrochlorothiazide (HCTZ) in diabetic patients with hypertension. Method:This study was a prospective randomized, open label, crossover study.Twenty two diabetic patients with hypertension were randomly assignedwith concealed allocation to receive either R-S tea (each sachet 2/0.2 g) 2sachets daily or HCTZ 25 mg once daily for 30 days. Then a two-waycrossover with a 7-day washout period was used. Serum and 24-hour urinespecimens were collected at the beginning and the end of each 30 daystreatment period. Diuretic effects were assessed from urinary sodiumexcretion and urinary volume. Results: After 30-day treatment periods, themean changes from baseline on urinary sodium excretion (-5.4±92.5 vs.-21.3±100.2 mmol/day, n=22) and urinary volume (-101.4±684.8 vs -40.5±806.4 mL, n=22) were not significantly difference between R-S teaand HCTZ respectively. HCTZ significantly increased serum glucose anddecreased serum potassium and chloride from baseline (p<0.05) but nosignificantly changed after R-S drinking. Nobody dropped out because ofadverse events. Conclusion: There was no statistically significantdifference in diuretic effects between R-S tea and HCTZ in hypertensivediabetic patients. Our result do not support diuretic effects from bothtreatments after 30 days.Keywords: Roselle, Stevia, diuretic, hydrochlorothiazide, hypertension,diabete

Evaluation of Intravenous Fosfomycin Disodium Dosing Regimens in Critically Ill Patients for Treatment of Carbapenem-Resistant Enterobacterales Infections Using Monte Carlo Simulation

There are limited intravenous fosfomycin disodium (IVFOS) dosing regimens to treat carbapenem-resistant Enterobacterales (CRE) infections. This study aimed to use Monte Carlo simulation (MCS) for evaluation of IVFOS dosing regimens in critically ill patients with CRE infections. The dosing regimens in critically ill patients with various creatinine clearance were evaluated with MCS using minimum inhibitory concentration (MIC) distributions of fosfomycin against CRE clinical isolates in Thailand and the 24 h area under the plasma drug concentration–time curve over the minimum inhibitory concentration (AUC0-24/MIC) of ≥21.5 to be a target for IVFOS. The achieved goal of the probability of target attainment (PTA) and a cumulative fraction of response (CFR) were ≥90%. A total of 129 non-duplicated CRE clinical isolates had MIC distributions from 0.38 to >1024 mg/L. IVFOS 8 g every 8 h, 1 h, or 4 h infusion, could achieve approximately 90% PTA of AUC0-24/MIC target to treat CRE infections with MICs ≤ 128 mg/L. According to PTA target, an IVFOS daily dose to treat carbapenem-resistant Escherichia coli based on Clinical Laboratory Standards Institute (CLSI) breakpoints for urinary tract infections and one to treatment for CRE infections based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints were 16 g/day and 8 g/day, respectively. All dosing regimens of IVFOS against CRE achieved CFR ≤ 70%. This study proposes the IVFOS dosing regimens based on CLSI and EUCAST breakpoints for the treatment of CRE infections. However, further clinical studies are needed to confirm the results of these findings