In response to the rise of drug-resistant pathogens, doctors are routinely cautioned against overprescribing antimicrobials. But when a patient has a confirmed bacterial infection, the advice is to treat aggressively to quash the infection before the bacteria can develop resistance. A new study questions the accepted wisdom that aggressive treatment with high drug dosages and long durations is always the best way to stem the emergence and spread of resistant pathogens. The review of nearly 70 studies of antimicrobial resistance, which was authored by researchers at Princeton and other leading institutions, and published online in an open-access article on September 24, 2014 in the journal Proceedings of the Royal Society B, reveals the lack of evidence behind the practice of aggressive treatment in many cases. The article was entitled, “The Path of Least Resistance: Aggressive or Moderate Treatment?” "We found that while there are many studies that test for resistance emergence between different drug regimens, surprisingly few have looked at the topic of how varying drug dosage might affect the emergence and spread of resistance," said Ruthie Birger, a Princeton graduate student who works with Dr. C. Jessica Metcalf, an assistant professor of ecology and evolutionary biology and public affairs at Princeton's Woodrow Wilson School, and Dr. Bryan Grenfell, the Kathryn Briger and Sarah Fenton Professor of Ecology and Evolutionary Biology and Public Affairs in Princeton's Woodrow Wilson School. Birger, Drs. Metcalf and Grenfell coauthored the paper with colleagues from 16 universities. "We are a long way from having the evidence for the best treatment decisions with respect to resistance for a range of diseases," Dr. Birger said.
Login Or Register To Read Full Story