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 Fraser Read, David L. Smith & 3 others Claire Standley, Nina Wale, Bryan Grenfell

Research output: Contribution to journalReview article

40 Citations (Scopus)

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

Fingerprint

Drug dosage
Patient treatment
Chemotherapy
Pathogens
Drug Resistance
Pharmaceutical Preparations
drug
Morbidity
drug resistance
chemotherapy
Pressure
Drug Therapy
drugs
duration
Mortality
morbidity
Therapeutics
dosage
conceptual framework
drug therapy

All Science Journal Classification (ASJC) codes

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

Cite this

Kouyos, R. D., Metcalf, C. J. E., Birger, R., Klein, E. Y., zur Wiesch, P. A., Ankomah, P., ... 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
Kouyos, Roger D. ; Metcalf, C. Jessica E. ; Birger, Ruthie ; Klein, Eili Y. ; zur Wiesch, Pia Abel ; Ankomah, Peter ; Arinaminpathy, Nimalan ; Bogich, Tiffany L. ; Bonhoeffer, Sebastian ; Brower, Charles ; Chi-Johnston, Geoffrey ; Cohen, Ted ; Day, Troy ; Greenhouse, Bryan ; Huijben, Silvie ; Metlay, Joshua ; Mideo, Nicole ; Pollitt, Laura C. ; Read, Andrew Fraser ; Smith, David L. ; Standley, Claire ; Wale, Nina ; Grenfell, Bryan. / The path of least resistance : Aggressive or moderate treatment?. In: Proceedings of the Royal Society B: Biological Sciences. 2014 ; Vol. 281, No. 1794.
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title = "The path of least resistance: Aggressive or moderate treatment?",
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.",
author = "Kouyos, {Roger D.} and Metcalf, {C. Jessica E.} and Ruthie Birger and Klein, {Eili Y.} and {zur Wiesch}, {Pia Abel} and Peter Ankomah and Nimalan Arinaminpathy and Bogich, {Tiffany L.} and Sebastian Bonhoeffer and Charles Brower and Geoffrey Chi-Johnston and Ted Cohen and Troy Day and Bryan Greenhouse and Silvie Huijben and Joshua Metlay and Nicole Mideo and Pollitt, {Laura C.} and Read, {Andrew Fraser} and Smith, {David L.} and Claire Standley and Nina Wale and Bryan Grenfell",
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Kouyos, RD, Metcalf, CJE, Birger, R, Klein, EY, zur Wiesch, PA, Ankomah, P, Arinaminpathy, N, Bogich, TL, Bonhoeffer, S, Brower, C, Chi-Johnston, G, Cohen, T, Day, T, Greenhouse, B, Huijben, S, Metlay, J, Mideo, N, Pollitt, LC, Read, AF, Smith, DL, Standley, C, Wale, N & Grenfell, B 2014, 'The path of least resistance: Aggressive or moderate treatment?', Proceedings of the Royal Society B: Biological Sciences, vol. 281, no. 1794, 20140566. https://doi.org/10.1098/rspb.2014.0566

The path of least resistance : Aggressive or moderate treatment? / Kouyos, Roger D.; Metcalf, C. Jessica E.; Birger, Ruthie; Klein, Eili Y.; zur Wiesch, Pia Abel; Ankomah, Peter; Arinaminpathy, Nimalan; Bogich, Tiffany L.; Bonhoeffer, Sebastian; Brower, Charles; Chi-Johnston, Geoffrey; Cohen, Ted; Day, Troy; Greenhouse, Bryan; Huijben, Silvie; Metlay, Joshua; Mideo, Nicole; Pollitt, Laura C.; Read, Andrew Fraser; Smith, David L.; Standley, Claire; Wale, Nina; Grenfell, Bryan.

In: Proceedings of the Royal Society B: Biological Sciences, Vol. 281, No. 1794, 20140566, 24.09.2014.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The path of least resistance

T2 - Aggressive or moderate treatment?

AU - Kouyos, Roger D.

AU - Metcalf, C. Jessica E.

AU - Birger, Ruthie

AU - Klein, Eili Y.

AU - zur Wiesch, Pia Abel

AU - Ankomah, Peter

AU - Arinaminpathy, Nimalan

AU - Bogich, Tiffany L.

AU - Bonhoeffer, Sebastian

AU - Brower, Charles

AU - Chi-Johnston, Geoffrey

AU - Cohen, Ted

AU - Day, Troy

AU - Greenhouse, Bryan

AU - Huijben, Silvie

AU - Metlay, Joshua

AU - Mideo, Nicole

AU - Pollitt, Laura C.

AU - Read, Andrew Fraser

AU - Smith, David L.

AU - Standley, Claire

AU - Wale, Nina

AU - Grenfell, Bryan

PY - 2014/9/24

Y1 - 2014/9/24

N2 - 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.

AB - 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.

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U2 - 10.1098/rspb.2014.0566

DO - 10.1098/rspb.2014.0566

M3 - Review article

VL - 281

JO - Proceedings of the Royal Society B: Biological Sciences

JF - Proceedings of the Royal Society B: Biological Sciences

SN - 0962-8452

IS - 1794

M1 - 20140566

ER -

Kouyos RD, Metcalf CJE, Birger R, Klein EY, zur Wiesch PA, Ankomah P et al. The path of least resistance: Aggressive or moderate treatment? Proceedings of the Royal Society B: Biological Sciences. 2014 Sep 24;281(1794). 20140566. https://doi.org/10.1098/rspb.2014.0566