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In general when two compounds
are administered they will not have the same pharmacokinetics. An example of two compounds
is shown in which concentrations have been normalized to MIC so that data for both
compounds can be plotted on the same scale. What you see is a period (#1) in which
compound 1 is present by itself above the MIC; conditions would be the same as monotherapy
for this compound during time period #1. During period #2 both compounds are above MIC;
thus cells would need a pair of mutations to be resistant. During period #3, only one
compound is above MIC, and again the conditions will be equivalent to monotherapy. During
the periods of monotherapy resistant mutants should be enriched. Repeated treatment of
this type interspersed with bacterial population outgrowth, should lead to resistance
(18). |