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一个量化扩大抗生素使用的个体效益与群体效益之间权衡的理论框架。

A Theoretical Framework to Quantify the Tradeoff Between Individual and Population Benefits of Expanded Antibiotic Use.

作者信息

LaPrete Cormac R, Ahmed Sharia M, Toth Damon J A, Reimer Jody R, Vaughn Valerie M, Adler Frederick R, Keegan Lindsay T

机构信息

Department of Mathematics, University of Utah, Salt Lake City, UT, USA.

Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.

出版信息

Bull Math Biol. 2025 Apr 30;87(6):68. doi: 10.1007/s11538-025-01432-2.

Abstract

The use of antibiotics during a disease outbreak presents a critical tradeoff between immediate treatment benefits to the individual and the long-term risk to the population. Typically, the extensive use of antibiotics has been thought to increase selective pressures, leading to resistance. This study explores scenarios where expanded antibiotic treatment can be advantageous for both individual and population health. We develop a mathematical framework to assess the impacts on outbreak dynamics of choosing to treat moderate infections not treated under current guidelines, focusing on cholera as a case study. We derive conditions under which treating moderate infections can sufficiently decrease transmission and reduce the total number of antibiotic doses administered. We identify two critical thresholds: the Outbreak Prevention Threshold (OPT), where expanded treatment reduces the reproductive number below 1 and halts transmission, and the Dose Utilization Threshold (DUT), where expanded treatment results in fewer total antibiotic doses used than under current guidelines. For cholera, we find that treating moderate infections can feasibly stop an outbreak when the untreated reproductive number is less than 1.42 and will result in fewer does used compared to current guidelines when the untreated reproductive number is less than 1.53. These findings demonstrate that conditions exist under which expanding treatment to include moderate infections can reduce disease spread and the selective pressure for antibiotic resistance. These findings extend to other pathogens and outbreak scenarios, suggesting potential targets for optimized treatment strategies that balance public health benefits and antibiotic stewardship.

摘要

在疾病爆发期间使用抗生素,体现了个体即时治疗益处与群体长期风险之间的关键权衡。通常认为,广泛使用抗生素会增加选择压力,导致耐药性产生。本研究探讨了扩大抗生素治疗在个体和群体健康方面均有益的情况。我们构建了一个数学框架,以评估选择治疗当前指南未涵盖的中度感染对疫情动态的影响,重点以霍乱为例进行研究。我们推导了治疗中度感染能够充分降低传播并减少抗生素总使用剂量的条件。我们确定了两个关键阈值:疫情预防阈值(OPT),即扩大治疗可使繁殖数降至1以下并停止传播;剂量利用阈值(DUT),即扩大治疗导致使用的抗生素总剂量比现行指南更少。对于霍乱,我们发现当未治疗时的繁殖数小于1.42时,治疗中度感染可切实阻止疫情爆发;当未治疗时的繁殖数小于1.53时,与现行指南相比,使用的剂量将更少。这些发现表明,存在扩大治疗范围以包括中度感染可减少疾病传播和抗生素耐药性选择压力的情况。这些发现适用于其他病原体和疫情场景,为平衡公共卫生益处与抗生素管理的优化治疗策略提供了潜在目标。

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