Data from: Aggressive chemotherapy and the selection of drug resistant pathogens

Drug resistant pathogens are one of the key public health challenges of
the 21st century. There is a widespread belief that resistance is best
managed by using drugs to rapidly eliminate target pathogens from patients
so as to minimize the probability that pathogens acquire resistance de
novo. Yet strong drug pressure imposes intense selection in favor of
resistance through alleviation of competition with wild-type populations.
Aggressive chemotherapy thus generates opposing evolutionary forces which
together determine the rate of drug resistance emergence. Identifying
treatment regimens which best retard resistance evolution while maximizing
health gains and minimizing disease transmission requires empirical
analysis of resistance evolution in vivo in conjunction with measures of
clinical outcomes and infectiousness. Using rodent malaria in laboratory
mice, we found that less aggressive chemotherapeutic regimens
substantially reduced the probability of onward transmission of resistance
(by >150-fold), without compromising health outcomes. Our
experiments suggest that there may be cases where resistance evolution can
be managed more effectively with treatment regimens other than those which
reduce pathogen burdens as fast as possible.