English to Spanish Medical Medical (general)

Our model uses these observations to make clinical predictions of therapy failure. We demonstrate how under-dosing and prolonged regimens select out strains, which may subsequently generate mutants with higher MICs. We identify a regimen-specific threshold vancomycin concentration below which, increasing dose leads to increased selection of VISA and treatment failure (see figure). Once above the threshold, therapy is successful. For longer dose intervals, regrowth of sensitive MRSA strains prevents eradication. Exact prediction of the threshold concentrations in vivo requires further estimation of key PD parameters, namely the slope of the concentration-kill curve and the peak Emax kill rate.CONCLUSIONS: Under-dosing and long dose interval regimens can effectively select out VISA strains. We identify an intermediate region where the inter-dosing period can give rise to considerable selection pressure and the eventual emergence of VISA