Evaluating treatment protocols to prevent antibiotic resistance
Evaluating treatment protocols to prevent antibiotic resistance
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DOI：
10.1073/pnas.94.22.12106
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发表时间：
1997-10-28
影响因子：
11.1
通讯作者：
Levin, BR
中科院分区：
文献类型：
--
作者：
Bonhoeffer, S;Lipsitch, M;Levin, BR
对抗菌药物耐药的细菌的传播需要全人群的治疗策略来延迟或扭转抗生素耐药性的趋势。在这里，我们提出了新的标准，用于评估直接传播的细菌感染的治疗方案的人群范围内的影响，并讨论了不同的使用模式，为单一和多种抗生素治疗，一个数学模型表明，从引入抗生素，直到高频率的耐药性排除其使用的单一药物治疗的长期效益几乎是独立的抗生素使用的模式。当使用一种以上的抗生素时，在人群中顺序使用不同的抗生素（“循环”）总是劣于治疗策略，其中在任何给定时间，相同比例的人群接受不同的抗生素，然而，在大多数情况下，用抗生素组合治疗所有患者是最佳治疗策略。
The spread of bacteria resistant to antimicrobial agents calls for population-wide treatment strategies to delay or reverse the trend toward antibiotic resistance. Here we propose new criteria for the evaluation of the population-wide effects of treatment protocols for directly transmitted bacterial infections and discuss different usage patterns for single and multiple antibiotic therapy, A mathematical model suggests that the long-term benefit of single drug treatment from introduction of the antibiotic until a high frequency of resistance precludes its use is almost independent of the pattern of antibiotic use. When more than one antibiotic is employed, sequential use of different antibiotics in the population (''cycling'') is always inferior to treatment strategies where, at any given time, equal fractions of the population receive different antibiotics, However, treatment of all patients with a combination of antibiotics is in most cases the optimal treatment strategy.