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

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  • Travis C Porco
  • Daozhou Gao
  • James C Scott
  • Eunha Shim
  • Wayne T Enanoria
  • Alison P Galvani
  • Thomas M Lietman

Abstract

Background: 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”. Methods and Findings: 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. Conclusions: 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.

Suggested Citation

  • Travis C Porco & Daozhou Gao & James C Scott & Eunha Shim & Wayne T Enanoria & Alison P Galvani & Thomas M Lietman, 2012. "When Does Overuse of Antibiotics Become a Tragedy of the Commons?," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-12, December.
  • Handle: RePEc:plo:pone00:0046505
    DOI: 10.1371/journal.pone.0046505
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    References listed on IDEAS

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    1. Eunha Shim & Gretchen B. Chapman & Alison P. Galvani, 2010. "Decision Making with Regard to Antiviral Intervention during an Influenza Pandemic," Medical Decision Making, , vol. 30(4), pages 64-81, July.
    2. Carol Y. Lin, 2008. "Modeling Infectious Diseases in Humans and Animals by KEELING, M. J. and ROHANI, P," Biometrics, The International Biometric Society, vol. 64(3), pages 993-993, September.
    3. Telalagic, S., 2012. "Optimal Treatment of an SIS Disease with Two Strains," Cambridge Working Papers in Economics 1229, Faculty of Economics, University of Cambridge.
    4. Kevin R Foster & Hajo Grundmann, 2006. "Do We Need to Put Society First? The Potential for Tragedy in Antimicrobial Resistance," PLOS Medicine, Public Library of Science, vol. 3(2), pages 1-1, January.
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    Cited by:

    1. Andrew M Colman & Eva M Krockow & Edmund Chattoe-Brown & Carolyn Tarrant, 2019. "Medical prescribing and antibiotic resistance: A game-theoretic analysis of a potentially catastrophic social dilemma," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-13, April.
    2. Albert, Jason, 2021. "Strategic dynamics of antibiotic use and the evolution of antibiotic-resistant infections," International Journal of Industrial Organization, Elsevier, vol. 77(C).

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