Can I give the patient a one-time treatment?

One-Time Treatment: Not Recommended for Most Conditions

The question lacks specificity about the condition being treated, but based on the available evidence, one-time treatments are rarely appropriate in clinical medicine, and most therapeutic interventions require adequate trial durations to assess efficacy and achieve meaningful clinical outcomes.

General Principles for Treatment Duration

Adequate Trial Periods Are Essential

• Most therapies require 4-12 weeks to determine efficacy, and premature discontinuation prevents proper assessment of treatment benefit 1
• For medications, trials should last 4-8 weeks; for behavioral therapies, 8-12 weeks are needed before abandoning a treatment approach 1
• Practitioners should persist with new treatments for sufficient duration rather than rapidly cycling through options without establishing whether each therapy works 1

Disease-Specific Considerations

For Immune Thrombocytopenia (ITP):

• TPO-RAs are not one-time treatments but require ongoing therapy, though approximately 30% of patients may achieve long-term remission and discontinue treatment 1
• If first-line therapy produced a response lasting >6 months, re-treatment with the same agent is reasonable 1
• Abrupt interruptions should be avoided as they cause platelet fluctuations 1

For Gout:

• After a first flare with high-risk features (CKD stage ≥3, serum urate >9 mg/dL, or urolithiasis), urate-lowering therapy (ULT) should be initiated as ongoing treatment, not one-time 1
• For asymptomatic hyperuricemia, treatment is generally not recommended, making one-time therapy inappropriate 1

For Infections:

• Azithromycin can be given as a single 30 mg/kg dose for acute otitis media in pediatric patients, with clinical success rates of 75-87% 2
• However, for H. pylori eradication, 14-day regimens are recommended rather than shorter durations to maximize first-attempt success 1
• For intra-abdominal infections with complete source control, short courses of 3-5 days are appropriate, but not truly "one-time" 1

For Multiple Myeloma:

• All clinically relapsed patients with symptoms should be treated immediately and continuously, not with one-time therapy 1
• Treatment continues until disease progression or unacceptable toxicity 1

Key Pitfalls to Avoid

• Do not use inadequately short treatment trials that prevent assessment of true efficacy 1
• Avoid simultaneous initiation of multiple therapies without establishing the efficacy of individual treatments 1
• Do not abandon effective therapies prematurely based on unrealistic expectations of immediate response 1

Clinical Decision Algorithm

1. Identify the specific condition requiring treatment
2. Determine if acute infection (may allow shorter/single-dose regimens like azithromycin for otitis media) 2
3. For chronic conditions (ITP, gout, myeloma), plan for ongoing therapy with defined endpoints 1
4. Establish treatment goals and expected time to response before initiating therapy 1
5. Commit to adequate trial duration (minimum 4-12 weeks depending on condition) before declaring treatment failure 1

The only scenario where true one-time treatment is appropriate is specific acute infections where single-dose regimens have proven efficacy (e.g., azithromycin 30 mg/kg for pediatric otitis media) 2. For virtually all other conditions, ongoing or adequately-dosed courses are required for meaningful clinical benefit.