Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
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When Does Overuse of Antibiotics Become a Tragedy of the Commons?
Travis C. Porco<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>,</SUP><SUP>7</SUP>, Daozhou Gao<SUP>1</SUP>, James C. Scott<SUP>4</SUP>, Eunha Shim<SUP>5</SUP>, Wayne T. Enanoria<SUP>1</SUP><SUP>,</SUP><SUP>3</SUP>, Alison P. Galvani<SUP>6</SUP>, Thomas M. Lietman<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>7</SUP><SUP>,</SUP><SUP>8</SUP><SUP>*</SUP>
<SUP></SUP>
1 Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America, 2 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America, 3 Center for Infectious Disease and Emergency Readiness, University of California, Berkeley, California, United States of America, 4 Department of Mathematics and Statistics, Colby College, Waterville, Maine, United States of America, 5 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America, 6 School of Medicine, Yale University, New Haven, Connecticut, United States of America, 7 Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America, 8 Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
Abstract
Background
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?.
Methods and Findings
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.
Conclusions
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.
Citation: Porco TC, Gao D, Scott JC, Shim E, Enanoria WT, et al. (2012) When Does Overuse of Antibiotics Become a Tragedy of the Commons? PLoS ONE 7(12): e46505. doi:10.1371/journal.pone.0046505
Editor: D. William Cameron, University of Ottawa, Canada
Received: February 13, 2012; Accepted: August 31, 2012; Published: December 7, 2012
Copyright: ? 2012 Porco et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work supported in part by Research to Prevent Blindness and Modeling Infectious Disease Agent Study (NIH UO1 GM08778) and the authors are grateful for their support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: tom.lietman@ucsf.edu
-Travis C. Porco<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>,</SUP><SUP>7</SUP>, Daozhou Gao<SUP>1</SUP>, James C. Scott<SUP>4</SUP>, Eunha Shim<SUP>5</SUP>, Wayne T. Enanoria<SUP>1</SUP><SUP>,</SUP><SUP>3</SUP>, Alison P. Galvani<SUP>6</SUP>, Thomas M. Lietman<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>7</SUP><SUP>,</SUP><SUP>8</SUP><SUP>*</SUP>
<SUP></SUP>
1 Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America, 2 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America, 3 Center for Infectious Disease and Emergency Readiness, University of California, Berkeley, California, United States of America, 4 Department of Mathematics and Statistics, Colby College, Waterville, Maine, United States of America, 5 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America, 6 School of Medicine, Yale University, New Haven, Connecticut, United States of America, 7 Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America, 8 Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
Abstract
Background
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?.
Methods and Findings
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.
Conclusions
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.
Citation: Porco TC, Gao D, Scott JC, Shim E, Enanoria WT, et al. (2012) When Does Overuse of Antibiotics Become a Tragedy of the Commons? PLoS ONE 7(12): e46505. doi:10.1371/journal.pone.0046505
Editor: D. William Cameron, University of Ottawa, Canada
Received: February 13, 2012; Accepted: August 31, 2012; Published: December 7, 2012
Copyright: ? 2012 Porco et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work supported in part by Research to Prevent Blindness and Modeling Infectious Disease Agent Study (NIH UO1 GM08778) and the authors are grateful for their support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: tom.lietman@ucsf.edu
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