Assessing strategies for managing drug resistance in treatment of infectious disease: insights from queueing theory

Abstract

Antimicrobials have been instrumental in the treatment of infectious disease: responsible for worldwide infection control and reductions in disease-induced morbidity, and mortality. However, in every case where new chemotherapeutic agents have been introduced, resistance to them has eventually evolved. Principally, the current strategy for dealing with this problem is to invest heavily in drug development, with the hope that new drugs become available before all existing drugs lose their efficacy. Instead of focusing on the ‘development side’ of the problem, another possible strategy is to invest in methods of slowing evolution of resistance. We use a novel application of queueing theory to demonstrate that, when comparing equivalent changes in drug development versus evolution management, the latter has a much greater effect on ensuring a continued supply of effective antimicrobial agents. Our results therefore call for a reappraisal of the current emphasis on enhancing drug development as a means of managing resistance.