TY - JOUR TI - How competition governs whether moderate or aggressive treatment minimizes antibiotic resistance AU - Colijn, Caroline AU - Cohen, Ted A2 - Doebeli, Michael VL - 4 PY - 2015 DA - 2015/09/22 SP - e10559 C1 - eLife 2015;4:e10559 DO - 10.7554/eLife.10559 UR - https://doi.org/10.7554/eLife.10559 AB - Understanding how our use of antimicrobial drugs shapes future levels of drug resistance is crucial. Recently, there has been debate over whether an aggressive (i.e., high dose) or more moderate (i.e., lower dose) treatment of individuals will most limit the emergence and spread of resistant bacteria. In this study, we demonstrate how one can understand and resolve these apparently contradictory conclusions. We show that a key determinant of which treatment strategy will perform best at the individual level is the extent of effective competition between resistant and sensitive pathogens within a host. We extend our analysis to the community level, exploring the spectrum between strict inter-strain competition and strain independence. From this perspective as well, we find that the magnitude of effective competition between resistant and sensitive strains determines whether an aggressive approach or moderate approach minimizes the burden of resistance in the population. KW - drug resistance KW - antibiotic KW - modelling KW - competition JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -