Monotherapy determination

Determine baseline international normalized ratio (INR) and aPTT on DTI monotherapy... 

It is important to determine (1) whether the isolate is methicillin-susceptible or methicillin-resistant and (2) whether the patient has a prosthetic valve. For patients with no prosthetic material, methicillin-susceptible staphylococci treatment should consist of a penicillinase-resistant penicillin (e.g., nafcillin or oxacillin) with or without gentamicin, and for methicillin-resistant strains, therapy should consist of vancomycin (see Table 71-4). Combination therapy with aminoglycosides, when used in these patients, typically is given only during the first 3 to 5 days of therapy. In the absence of prosthetic material, some treatment guidelines do not recommend combination therapy against MRSA. However, many clinicians may combine either gentamicin or rifampin with vancomycin if the patient is unresponsive to monotherapy. 

The starting dose and dose adjustments for combination therapy are the same as repaglinide monotherapy. Carefully adjust the dose of each drug to determine the minimal dose required. 

Based on these initial phase II results, an expanded worldwide phase II pivotal study was performed to assess the efficacy and safety of trastuzumab monotherapy (249). This study enrolled 222 metastatic breast cancer patients whose tumors had HER2 overexpression and who had progressed after one or two prior chemotherapy regimens. As with previous trastuzumab studies, HER2 overexpression was determined by a centralized IHC assay, in which HER2 staining was required to be 2+ or 3+ on a 0 to 3+ scale. Patients received trastuzumab intravenously as a 4 mg/kg loading dose followed by 2 mg/kg weekly maintenance. 

Pittler and Ernst (11) conducted a review of double-blind, randomized, placebo-controlled trials of kava extract monotherapy for treatment of anxiety. They reviewed 14 such studies and three were determined suitable for metaanalysis. They concluded that kava extract was not only relatively safe but superior to placebo in the treatment of anxiety. 

In summary, 32AR Arg 16 homozygotes may be associated with decreased lung function and increased asthma exacerbation with regular SABA use. Subsequently, to determine the effect of Argl6—>Gly polymorphism on response to salmeterol monotherapy, Wechsler and colleagues... 

Friedman and colleagnes condncted a post hoc pharmacoeco-nomic evalnation of two mnlticenter, randomized trials comparing the combination of ipratropium and albnterol with both dmgs used as monotherapy. Patients who received a combination of ipratropium and albnterol had lower rates of exacerbations, lower overall treatment costs, and improved cost-effectiveness compared with either drng nsed alone. With the introdnction of new bronchodilator therapies, and with no clearly consistent advantage of one class of agents over another, pharmacoeconomic analyses may be nsefnl for clinicians in determining the most appropriate therapy for their patients. 

In relation to diabetic nephropathy, evaluation of the potential beneficial effects of dual-blockade therapy is a work in rapid progress, as indicated in Table 2. Although the studies show some divergence, the majority of data demonstrate significant reductions in either BP or albuminuria or in both factors. It should however be noted that the studies in general are small with short follow-up. As the optimal doses of both types of drug remain to be determined, it is also relevant to consider whether the same effect can be obtained by optimizing the dose of ACE-1 or ARB in monotherapy [53-55],... 

Further studies are needed to determine the risks in patienb with predbposing cardiac risk factors who are being treated with paclitaxel. A retrospective review of patienb with major cardiac risk factors who were treated with paclitaxel (either monotherapy or in combination with cbplatin or carbo-platin) did not find any evidence of reduced cardiac function after treatment with paclitaxel. However the series only consbted of 15 patients [36 ]. 

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