The path of least resistance: aggressive or moderate treatment?

Roger D. Kouyos, C. Jessica E. Metcalf, Ruthie Birger, Eili 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 journalArticle

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)
Pages (from-to)20140566
Number of pages1
JournalProceedings of the Royal Society B: Biological Sciences
Volume281
Issue number1794
DOIs
StatePublished - Nov 7 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

Keywords

  • drug resistance
  • evolution
  • treatment strategies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kouyos, R. D., Metcalf, C. J. E., Birger, R., Klein, E., 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

The path of least resistance : aggressive or moderate treatment? / Kouyos, Roger D.; Metcalf, C. Jessica E.; Birger, Ruthie; Klein, Eili; 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 F.; Smith, David L.; Standley, Claire; Wale, Nina; Grenfell, Bryan.

In: Proceedings of the Royal Society B: Biological Sciences, Vol. 281, No. 1794, 07.11.2014, p. 20140566.

Research output: Contribution to journalArticle

Kouyos, RD, Metcalf, CJE, Birger, R, Klein, E, 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, pp. 20140566. https://doi.org/10.1098/rspb.2014.0566
Kouyos, Roger D. ; Metcalf, C. Jessica E. ; Birger, Ruthie ; Klein, Eili ; 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 F. ; 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. pp. 20140566.
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