When Does Overuse of Antibiotics Become a Tragedy of the Commons?

• Published in: PloS one Vol. 7; no. 12; p. e46505
• Main Authors: Porco, Travis C., Gao, Daozhou, Scott, James C., Shim, Eunha, Enanoria, Wayne T., Galvani, Alison P., Lietman, Thomas M.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.12.2012; Public Library of Science (PLoS)
• Subjects: Analysis; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Biology; Conflicts of interest; Decision analysis; Decision making; Disease transmission; Drug resistance; Drug Resistance, Microbial; Epidemiology; Ethical aspects; Health aspects; Humans; Immunization; Incentives; Infections; Infectious diseases; Mathematical analysis; Mathematical models; Mathematics; Medical personnel; Medical societies; Medicine; Microbial drug resistance; Models, Biological; Morbidity; Ordinary differential equations; Organisms; Physicians; Population; Practice Patterns, Physicians; Self interest; Social aspects; Tuberculosis; United States > US; San Francisco California; California
• DOI: 10.1371/journal.pone.0046505
• ISSN: 1932-6203

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". 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. 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.