Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA.
PLoS One. 2012;7(12):e46505. doi: 10.1371/journal.pone.0046505. Epub 2012 Dec 7.
Over-prescribing of antibiotics is considered to result in increased morbidity and mortality from drug-resistant organisms. A resulting common wisdom is that it would be better for society if physicians would restrain their prescription of antibiotics. In this view, self-interest and societal interest are at odds, making antibiotic use a classic "tragedy of the commons".
We developed two mathematical models of transmission of antibiotic resistance, featuring de novo development of resistance and transmission of resistant organisms. We analyzed the decision to prescribe antibiotics as a mathematical game, by analyzing individual incentives and community outcomes.
A conflict of interest may indeed result, though not in all cases. Increased use of antibiotics by individuals benefits society under certain circumstances, despite the amplification of drug-resistant strains or organisms. In situations where increased use of antibiotics leads to less favorable outcomes for society, antibiotics may be harmful for the individual as well. For other scenarios, where a conflict between self-interest and society exists, restricting antibody use would benefit society. Thus, a case-by-case assessment of appropriate use of antibiotics may be warranted.
抗生素的过度使用被认为会导致耐药菌引起的发病率和死亡率增加。因此，人们普遍认为，如果医生能够控制抗生素的处方，对社会来说会更好。在这种观点下，个人利益和社会利益存在冲突，使抗生素的使用成为经典的“公地悲剧”。
我们开发了两种抗生素耐药性传播的数学模型，其特征是耐药性的新出现和耐药菌的传播。我们通过分析个人激励和社区结果，将开抗生素处方的决策视为一种数学博弈。
确实可能存在利益冲突，但并非在所有情况下都如此。在某些情况下，个体对抗生素的使用增加会使社会受益，尽管这会放大耐药菌株或耐药菌。在抗生素使用增加对社会产生不利结果的情况下，抗生素对个人也可能有害。对于其他情况下，个人利益和社会之间存在冲突，限制抗体的使用将使社会受益。因此，对抗生素使用的适当性进行逐案评估可能是必要的。
