The path of least resistance: Aggressive or moderate treatment?

Roger D. Kouyos, C. Jessica E. Metcalf, Ruthie Birger, Eili Y. Klein, Pia Abel zur Wiesch, Peter Ankomah, Nimalan Arinaminpathy, Tiffany L. Bogich, Sebastian Bonhoeffer, Charles Brower, Geoffrey Chi-Johnston, Ted Cohen, Troy Day, Bryan Greenhouse, Silvie Huijben, Joshua Metlay, Nicole Mideo, Laura C. Pollitt, Andrew F. Read, David L. SmithClaire Standley, Nina Wale, Bryan Grenfell

Research output: Contribution to journalReview article

49 Scopus citations

Abstract

The evolution of resistance to antimicrobial chemotherapy is a major and growing cause of human mortality and morbidity. Comparatively little attention has been paid to how different patient treatment strategies shape the evolution of resistance. In particular, it is not clear whether treating individual patients aggressively with high drug dosages and long treatment durations, or moderately with low dosages and short durations can better prevent the evolution and spread of drug resistance. Here, we summarize the very limited available empirical evidence across different pathogens and provide a conceptual framework describing the information required to effectively manage drug pressure to minimize resistance evolution.

Original languageEnglish (US)
Article number20140566
JournalProceedings of the Royal Society B: Biological Sciences
Volume281
Issue number1794
DOIs
StatePublished - Sep 24 2014

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Environmental Science(all)
  • Agricultural and Biological Sciences(all)

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    Kouyos, R. D., Metcalf, C. J. E., Birger, R., Klein, E. Y., zur Wiesch, P. A., Ankomah, P., Arinaminpathy, N., Bogich, T. L., Bonhoeffer, S., Brower, C., Chi-Johnston, G., Cohen, T., Day, T., Greenhouse, B., Huijben, S., Metlay, J., Mideo, N., Pollitt, L. C., Read, A. F., ... Grenfell, B. (2014). The path of least resistance: Aggressive or moderate treatment? Proceedings of the Royal Society B: Biological Sciences, 281(1794), [20140566]. https://doi.org/10.1098/rspb.2014.0566