"One-size-fits-all"? Optimizing treatment duration for bacterial infections.

Historically, antibiotic treatment guidelines have aimed to maximize treatment efficacy and minimize toxicity, but have not considered the evolution of antibiotic resistance. Optimizing the duration and dosing of treatment to minimize the duration of symptomatic infection and selection pressure for...

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Autores principales:	Patricia Geli, Ramanan Laxminarayan, Michael Dunne, David L Smith
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6593c87cc82044719953c5988f0dca28
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spelling	oai:doaj.org-article:6593c87cc82044719953c5988f0dca282021-11-18T07:30:28Z"One-size-fits-all"? Optimizing treatment duration for bacterial infections.1932-620310.1371/journal.pone.0029838https://doaj.org/article/6593c87cc82044719953c5988f0dca282012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22253798/?tool=EBIhttps://doaj.org/toc/1932-6203Historically, antibiotic treatment guidelines have aimed to maximize treatment efficacy and minimize toxicity, but have not considered the evolution of antibiotic resistance. Optimizing the duration and dosing of treatment to minimize the duration of symptomatic infection and selection pressure for resistance simultaneously has the potential to extend the useful therapeutic life of these valuable life-saving drugs without compromising the interests of individual patients.Here, using mathematical models, we explore the theoretical basis for shorter durations of treatment courses, including a range of ecological dynamics of bacteria that cause infections or colonize hosts as commensals. We find that immunity is an important mediating factor in determining the need for long duration of treatment. When immunity to infection is expected, shorter durations that reduce the selection for resistance without interfering with successful clinical outcome are likely to be supported. Adjusting drug treatment strategies to account for the impact of the differences in the ecological niche occupied by commensal flora relative to invasive bacteria could be effective in delaying the spread of bacterial resistance.Patricia GeliRamanan LaxminarayanMichael DunneDavid L SmithPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 1, p e29838 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Patricia Geli Ramanan Laxminarayan Michael Dunne David L Smith "One-size-fits-all"? Optimizing treatment duration for bacterial infections.
description	Historically, antibiotic treatment guidelines have aimed to maximize treatment efficacy and minimize toxicity, but have not considered the evolution of antibiotic resistance. Optimizing the duration and dosing of treatment to minimize the duration of symptomatic infection and selection pressure for resistance simultaneously has the potential to extend the useful therapeutic life of these valuable life-saving drugs without compromising the interests of individual patients.Here, using mathematical models, we explore the theoretical basis for shorter durations of treatment courses, including a range of ecological dynamics of bacteria that cause infections or colonize hosts as commensals. We find that immunity is an important mediating factor in determining the need for long duration of treatment. When immunity to infection is expected, shorter durations that reduce the selection for resistance without interfering with successful clinical outcome are likely to be supported. Adjusting drug treatment strategies to account for the impact of the differences in the ecological niche occupied by commensal flora relative to invasive bacteria could be effective in delaying the spread of bacterial resistance.
format	article
author	Patricia Geli Ramanan Laxminarayan Michael Dunne David L Smith
author_facet	Patricia Geli Ramanan Laxminarayan Michael Dunne David L Smith
author_sort	Patricia Geli
title	"One-size-fits-all"? Optimizing treatment duration for bacterial infections.
title_short	"One-size-fits-all"? Optimizing treatment duration for bacterial infections.
title_full	"One-size-fits-all"? Optimizing treatment duration for bacterial infections.
title_fullStr	"One-size-fits-all"? Optimizing treatment duration for bacterial infections.
title_full_unstemmed	"One-size-fits-all"? Optimizing treatment duration for bacterial infections.
title_sort	"one-size-fits-all"? optimizing treatment duration for bacterial infections.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/6593c87cc82044719953c5988f0dca28
work_keys_str_mv	AT patriciageli onesizefitsalloptimizingtreatmentdurationforbacterialinfections AT ramananlaxminarayan onesizefitsalloptimizingtreatmentdurationforbacterialinfections AT michaeldunne onesizefitsalloptimizingtreatmentdurationforbacterialinfections AT davidlsmith onesizefitsalloptimizingtreatmentdurationforbacterialinfections
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"One-size-fits-all"? Optimizing treatment duration for bacterial infections.

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