阻力最小的途径：积极治疗还是适度治疗？
The path of least resistance: aggressive or moderate treatment?
作者信息
Kouyos Roger D, Metcalf C Jessica E, Birger Ruthie, Klein Eili Y, Abel zur Wiesch Pia, 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
机构信息
Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA Department of Zoology, Oxford University, Oxford, UK.
出版信息
Proc Biol Sci. 2014 Nov 7;281(1794):20140566. doi: 10.1098/rspb.2014.0566.
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.
对抗菌化疗产生耐药性的演变是导致人类死亡和发病的一个主要且日益严重的原因。相对而言，对于不同的患者治疗策略如何影响耐药性的演变，人们关注较少。特别是，目前尚不清楚采用高剂量药物和长时间疗程积极治疗个体患者，还是采用低剂量药物和短疗程适度治疗，能否更好地预防耐药性的演变和传播。在此，我们总结了不同病原体方面非常有限的现有实证证据，并提供了一个概念框架，描述有效管理药物压力以尽量减少耐药性演变所需的信息。
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