Dissemin is shutting down on January 1st, 2025

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The Royal Society, Proceedings of the Royal Society B: Biological Sciences, 1794(281), p. 20140566, 2014

DOI: 10.1098/rspb.2014.0566

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The path of least resistance: aggressive or moderate treatment?

Journal article published in 2014 by Roger D. Kouyos, Pia Abel zur Wiesch, C. Jessica E. Metcalf, C. Jessica E. Metcalf, Ruthie Birger ORCID, Eili Y. Klein, Pia Abel zur Wiesch, Peter Ankomah, Nimalan Arinaminpathy, Tiffany L. Bogich, Sebastian Bonhoeffer, Charles Brower, Geoffrey Chi-Johnston, Ted Cohen ORCID, Troy Day and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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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.