title: Antibiotic Restriction Might Facilitate the Emergence of Multi-drug Resistance.
abstract: High antibiotic resistance frequencies have become a major public health issue. The decrease in new antibiotics' production, combined with increasing frequencies of multi-drug resistant (MDR) bacteria, cause substantial limitations in treatment options for some bacterial infections. To diminish overall resistance, and especially the occurrence of bacteria that are resistant to all antibiotics, certain drugs are deliberately scarcely used--mainly when other options are exhausted. We use a mathematical model to explore the efficiency of such antibiotic restrictions. We assume two commonly used drugs and one restricted drug. The model is examined for the mixing strategy of antibiotic prescription, in which one of the drugs is randomly assigned to each incoming patient. Data obtained from Rabin medical center, Israel, is used to estimate realistic single and double antibiotic resistance frequencies in incoming patients. We find that broad usage of the hitherto restricted drug can reduce the number of incorrectly treated patients, and reduce the spread of bacteria resistant to both common antibiotics. Such double resistant infections are often eventually treated with the restricted drug, and therefore are prone to become resistant to all three antibiotics. Thus, counterintuitively, a broader usage of a formerly restricted drug can sometimes lead to a decrease in the emergence of bacteria resistant to all drugs. We recommend re-examining restriction of specific drugs, when multiple resistance to the relevant alternative drugs already exists.
authors.affiliation: Department of Molecular Biology and Ecology of Plants, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Obolski
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv, Israel.
authors.forename: Gideon Y
authors.initials: GY
authors.lastname: Stein
authors.affiliation: Department of Molecular Biology and Ecology of Plants, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Lilach
authors.initials: L
authors.lastname: Hadany
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D019295:Computational Biology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D006801:Humans; D008954:Models, Biological
chemical_list: D000900:Anti-Bacterial Agents