Open AccessMedical prescribing and antibiotic resistance: A game-theoretic analysis of a potentially catastrophic social dilemma
Author(s) -
Andrew M. Colman,
Eva M. Krockow,
Edmund ChattoeBrown,
Carolyn Tarrant
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0215480
Subject(s) - dilemma , antibiotics , antibiotic resistance , social dilemma , population , intensive care medicine , medical prescription , medicine , game theory , resistance (ecology) , replicator equation , evolutionary game theory , risk analysis (engineering) , biology , economics , environmental health , microeconomics , ecology , pharmacology , microbiology and biotechnology , philosophy , epistemology
The availability of antibiotics presents medical practitioners with a prescribing dilemma. On the one hand, antibiotics provide a safe and effective treatment option for patients with bacterial infections, but at a population level, over-prescription reduces their effectiveness by facilitating the evolution of bacteria that are resistant to antibiotic medication. A game-theoretic investigation, including analysis of equilibrium strategies, evolutionarily stability, and replicator dynamics, reveals that rational doctors, motivated to attain the best outcomes for their own patients, will prescribe antibiotics irrespective of the level of antibiotic resistance in the population and the behavior of other doctors, although they would achieve better long-term outcomes if their prescribing were more restrained. Ever-increasing antibiotic resistance may therefore be inevitable unless some means are found of modifying the payoffs of this potentially catastrophic social dilemma.