Bonhoeffer S, Lipsitch M, Levin B R
Wellcome Trust Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, United Kingdom.
Proc Natl Acad Sci U S A. 1997 Oct 28;94(22):12106-11. doi: 10.1073/pnas.94.22.12106.
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.
对抗菌药物产生耐药性的细菌传播,需要采取全人群治疗策略来延缓或扭转抗生素耐药性的趋势。在此,我们提出了评估直接传播细菌感染治疗方案全人群效应的新标准,并讨论了单一和多种抗生素治疗的不同使用模式。一个数学模型表明,从引入抗生素到耐药性高发导致其无法使用期间,单一药物治疗的长期益处几乎与抗生素使用模式无关。当使用一种以上抗生素时,在人群中序贯使用不同抗生素(“循环用药”)总是不如在任何给定时间让相同比例人群接受不同抗生素的治疗策略。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。