The path of least resistance: aggressive or moderate treatment?
Proceedings. Biological Sciences
Anti-Infective Agents--administration & dosage; Biological Evolution; Drug Resistance, Microbial--genetics; Infection--drug therapy
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.
Kouyos, R. D., Metcalf, C. J. E., Birger, R., Klein, E. Y., Abel zur Wiesch, P., et al. (2014). The path of least resistance: aggressive or moderate treatment? Proceedings of the Royal Society B: Biological Sciences, 281(1794), 20140566.