Evaluating treatment protocols to prevent antibiotic resistance.
The spread of bacteria resistant to antimicrobial agents calls for population-wide treatment strategies to delay or reverse the trend toward antibiotic resistance. Here we propose new criteria for the evaluation of the population-wide effects of treatment protocols for directly transmitted bacterial infections and discuss different usage patterns for single and multiple antibiotic therapy. A mathematical model suggests that the long-term benefit of single drug treatment from introduction of the antibiotic until a high frequency of resistance precludes its use is almost independent of the pattern of antibiotic use. When more than one antibiotic is employed, sequential use of different antibiotics in the population ("cycling") is always inferior to treatment strategies where, at any given time, equal fractions of the population receive different antibiotics. However, treatment of all patients with a combination of antibiotics is in most cases the optimal treatment strategy.
Bonhoeffer
S
S
Wellcome Trust Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, United Kingdom.
Lipsitch
M
M
Levin
B R
BR
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002985:Clinical Protocols; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004358:Drug Therapy / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D006291:Health Policy; D006801:Humans; D008962:Models, Theoretical; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents