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Chapter 6 : Human Interventions on the Evolution of Host-Bacterium Interactions
Bacterial infections pose a serious threat to human health; antibiotics are a powerful remedy. This chapter discusses the biological background for the evolution of antibiotic resistance and reviews some of the possible ways that humans can intervene. It focuses on a priori justification for the interventions, the difficulties in implementing them, and some evidence for their success. The problem of resistance to antibiotics in bacteria spans many academic disciplines, including ecology, microbiology, medicine, nursing, bacterial genetics, evolutionary biology, economics, statistics, and mathematics. Colonization and infection define the ecological and epidemiological background for the evolution of antibiotic resistance. The evolution of antibiotic resistance involves two processes: emergence and spread. Thresholds may be most important as motivating concepts for understanding the dynamics and control of antibiotic resistance. The chapter examines the way antibiotics are typically used and strategies for reducing use or manipulating antibiotic use to reduce the spread of resistance. The use of antibiotics is a major perturbation to microbial communities. The evolution of resistance has economic causes as well as biological ones. Sufficient investment in the types of solutions discussed here, and research to support their use could reduce resistance, but without an understanding of the current incentives and without structural changes, these solutions are not likely to reverse current trends.