Management of drug resistance in the population: influenza as a case study

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Abstract
The rise of drug resistance remains a major impediment to the treatment of some diseases caused by fast-evolving pathogens that undergo genetic mutations. Models describing the within-host infectious dynamics suggest that the resistance is unlikely to emerge if the pathogen-specific immune responses are maintained above a certain threshold during therapy. However, emergence of resistance in the population involves both within-host and between-host infection mechanisms. Here, we employ a mathematical model to identify an effective treatment strategy for the management of drug resistance in the population. We show that, in the absence of pre-existing immunity, the population-wide spread of drug-resistant pathogen strains can be averted if a sizable portion of susceptible hosts is depleted before drugs are used on a large scale. The findings, based on simulations for influenza infection as a case study, suggest that the initial prevalence of the drug-sensitive strain under low pressure of drugs, followed by a timely implementation of intensive treatment, can minimize the total number of infections while preventing outbreaks of drug-resistant infections.

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