Selecting optimal treatment

The goal of this chapter was to organize the existing knowledge of the various antidepressants based on their clinical pharmacological class to aid the clinician in selecting the optimal treatment for a patient. 

Recently, worldwide consensus statements regarding management and treatment of acne have been widely distributed to improve and optimize outcomes. See Table 95-2 for highlights of consensus statements from The Global Alliance to Improve Outcomes in Acne. Figure 95-2 provides acne treatment algorithms based on acne severity. See Table 95-3 for the action spectra of selected acne treatments. 

Because approximately two-thirds of patients who undergo resection of hepatic metastases will have disease recurrence, adjuvant systemic and hepatic arterial infusion chemotherapy have been studied in an attempt to improve long-term outcomes. A randomized trial that compared 6 months of hepatic floxuridine and dexamethasone plus TV fluorouracil with leucovorin to TV fluorouracil with leucov-orin alone following resection of hepatic metastases in 156 patients showed improved 2-year DPS (86% vs. 72%) and hepatic recurrence-free survival at 2 years (90% vs. 60%) with the combined therapy. Many practitioners offer adjuvant chemotherapy to select patients following potentially curative hepatic resection, but further studies, especially those involving more active agents, are needed to determine an optimal treatment regimen. ... 

The limited efficacy and potential toxicity of many of today s medications, coupled with the rapidly expanding portfolio of medications for disease treatment and prevention, creates enormous complexity in selecting optimal medications for individual patients. Thus, the expertise of clinically educated and trained pharmacists is increasingly important if we are to ensure patients receive the most effective medications in the doses and combinations that are optimal for them and their illnesses. 

The procedural mortality for metallic stent insertion is very low (0%-1.4%) (Acunas et al. 1996 Cwikiel et al. 1998 Song et al. 1994 Laasch et al. 1998 Saxon et al. 1995 Morgan et al. 1996). Procedural mortality is mainly due to comorbidity rather than trauma sustained as a result of the stent insertion procedure itself. It can be minimized by careful patient selection, optimization of patients before the procedure (e.g., by correction of electrolyte imbalances and treatment of chest infections with appropriate antibiotics and chest physiotherapy), and careful use of intravenous sedation. If possible, the use of sedation should be kept to a minimum. Stents can be inserted without... 

Last, the dehydration eost is directly influenced by chemical selection. Poor chemical selection will result in a non-optimized treatment, whieh will mean higher costs. Chemical selection is not a simple proeess— it is best left to suppliers. However, one can assist... 

Promoting Optimal Response to Therapy The results of a culture and sensitivity test take several days because time must be allowed for the bacteria to grow on the culture media However, infections are treated as soon as possible In a few instances, the primary health care provider may determine that a penicillin is the treatment of choice until the results of the culture and sensitivity tests are known. In many instances, the primary health care provider selects a broad-spectrum antibiotic (ie, an antibiotic that is effective against many types or strains of bacteria) for initial treatment because of the many penicillin-resistant strains of microorganisms. 

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