A theoretical framework to quantify the tradeoff between individual and population benefits of expanded antibiotic use

Abstract

AbstractThe 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 1.424 and will result in fewer does used compared to current guidelines when the untreated reproductive number is less than 1.533. 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.