How competition governs whether moderate or aggressive treatment minimizes antibiotic resistance
- Imperial College London, United Kingdom
- Yale University, United States
Abstract
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. Here 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.
Article and author information
Author details
Reviewing Editor
- Michael Doebeli, University of British Columbia, Canada
Version history
- Received: August 3, 2015
- Accepted: September 18, 2015
- Accepted Manuscript published: September 22, 2015 (version 1)
- Accepted Manuscript updated: September 25, 2015 (version 2)
- Version of Record published: November 11, 2015 (version 3)
Copyright
© 2015, Colijn & Cohen
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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How competition governs whether moderate or aggressive treatment minimizes antibiotic resistance
eLife 4:e10559.
https://doi.org/10.7554/eLife.10559
Further reading
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A mathematical model has been used to explore different approaches to minimizing antibiotic resistance.
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