Module 1

When faced with a choice between 2 or more possible answers, using a “STEPS” analysis may be a useful clinical decision making tool.  The goal is to provide information for each agent and compare the results to aid in your decision.  
S:  safety – are there any serious drug interactions?  Possible serious side effects or adverse drug reactions?
T – tolerability – consider any adverse drug effects or side effects that may be concerning to the patient such as:  diarrhea, headaches, rash, etc.
E – efficacy – is one agent more efficacious than the other for the infection?
P – price – does the patient have insurance?  will cost inhibit adherence or access to the medication?
S – simplicity – which regimen is simpler?  Once a day dosing will likely have better adherence rates than three times a day dosing.  Also, three days of an antibiotic may be preferable to 7-10 days.  Depending on the drug you choose, the frequency and duration will vary.
Here’s an example table
Drug 1Drug 2SafetyModerate drug interactions             No drug interactions / serious ADRsTolerabilityDiarrheaDiarrhea, headachesEfficacySimilarSimilarPrice/Preference$100/7 days$30/3 daysSimplicity7 days, once daily dosing3 days, BID dosing

1.  Which one would you choose and why?
2.  Identify the available treatment strategies for CAP in an adult outpatient with comorbidities. Create your own “steps” analysis comparing the use of the available treatment regimens. Be prepared to compare and contrast your ideas with your classmates.
Reference:  Evaluating the safety and effectiveness of new drugs

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