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Indeed, when you consider the
traditional pharmacodynamic strategies within the context of the selection window, you see
that unlike the MPC idea, they allow concentrations to be inside the window. In principle,
you could have a very high value for a pharmacodynamic parameter and remain inside the
window throughout therapy. This is because traditional pharmacodynamics is aimed at curing
disease, not stopping resistance. In microbiological terms, traditional pharmacodynamics
uses drug activity against susceptible cells (MIC) as its point of reference rather than
activity against resistant mutants. Another important feature is the empirical nature of
traditional pharmacodynamic measurements: values were obtained from clinical studies that
revealed thresholds for successful therapy with respect to cure. For such studies patient
numbers in the hundreds were deemed suitable. Using an empirical approach to define doses
that will block the increase in resistance prevalence may require testing many, many more
patients because on a per-patient basis resistance generally arises rarely. |