How competition governs whether moderate or aggressive treatment minimizes antibiotic resistance

  1. C Colijn  Is a corresponding author
  2. T Cohen
  1. Imperial College London, United Kingdom
  2. 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.

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Author details

  1. C Colijn

    Department of Mathematics, Imperial College London, London, United Kingdom
    For correspondence
    c.colijn@imperial.ac.uk
    Competing interests
    The authors declare that no competing interests exist.
  2. T Cohen

    School of Public Health, Yale University, New Haven, United States
    Competing interests
    The authors declare that no competing interests exist.

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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  1. C Colijn
  2. T Cohen
(2015)
How competition governs whether moderate or aggressive treatment minimizes antibiotic resistance
eLife 4:e10559.
https://doi.org/10.7554/eLife.10559

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https://doi.org/10.7554/eLife.10559

Further reading

  1. A mathematical model has been used to explore different approaches to minimizing antibiotic resistance.