The path of least resistance: aggressive or moderate treatment?

Type: Article

The Question

Which method better prevents the spread of antibiotic resistance: aggressive treatment (high drug dosages and long treatment options for antimicrobials) or moderate treatment (low dosages and short durations)?

What we found

From an ecological perspective, drug resistance depends on two opposite processes: parasite abundance and strength of selection. The relative strength of these processes correlates with the two strategies of aggressive and moderate treatment – aggressive treatment deals directly with parasite abundance, and moderate treatment with selection strength. We created a conceptual curve of the two processes that defines resistance evolution as a function of drug pressure, which can be used to find optimal treatment strategies. Important determinants for finding this optimal point on the curve include genetic architecture underlying resistance, community resistance levels, and patience compliance with anti-infective therapy.

Empirical evidence is still largely lacking in favor of either treatment, so further study is critical to determine both ideal treatments for specific pathogen-drug combinations as well as general best practices for treatment.

Why it matters

Since they were first introduced in the early 1940s, antibiotics and other anti-infectives have been a critical public health tool for fighting disease. However, as use of these therapies has risen, the bacteria they fight have evolved to resist them, and this has become an increasingly significant problem.

One of the most important strategies for combating antibiotic resistance is good stewardship, or using the drug therapies we currently have in the best way possible to prevent increased resistance. A critical question to ask, then, is what treatment methods (aggressive or moderate) are most effective at combating resistance.