Antibiotic treatment, duration of infectiousness, and disease transmission

TL;DR

This paper models how antibiotic treatment can paradoxically increase disease transmission by prolonging infectiousness, depending on within-host dynamics and treatment timing.

Contribution

It introduces a deterministic within-host model linking pathogen density to transmission and recovery, revealing conditions where antibiotics may enhance disease spread.

Findings

Antibiotic treatment can increase infectious period under certain conditions.

Lower antibiotic efficacy may turn rare diseases into common, treatable infections.

Within-host dynamics critically influence between-host transmission outcomes.

Abstract

Humans, domestic animals, orchard crops, and ornamental plants are commonly treated with antibiotics in response to bacterial infection. By curing infectious individuals, antibiotic therapy might limit the spread of contagious disease among hosts. But an antibiotic`s suppression of within-host pathogen density might also reduce the probability that the host is otherwise removed from infectious status prior to therapeutic recovery. When rates of both recovery via treatment and other removal events (e.g., isolation or mortality) depend directly on within-host pathogen density, antibiotic treatment can relax the overall removal rate sufficiently to increase between-host disease transmission. To explore this dependence, a deterministic within-host dynamics drives the infectious host's time-dependent probability of disease transmission, as well as the probabilistic duration of the infectious period. At the within-host scale, the model varies (1) inoculum size, (2) bacterial self-regulation, (3) the time between infection and initiation of therapy, and (4) antibiotic efficacy. At the between-host scale the model varies (5) the size/susceptibility of groups randomly encountered by an infectious host. Results identify conditions where antibiotic treatment can increase duration of a host`s infectiousness, and consequently increase the expected number of new infections. At lower antibiotic efficacy, treatment might convert a rare, serious bacterial disease into a common, but treatable infection.