PerspectiveInfectious Disease

Tolerance to antibiotics affects response

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Science  10 Jan 2020:
Vol. 367, Issue 6474, pp. 141-142
DOI: 10.1126/science.aba0150

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Summary

Antimicrobial resistance is increasing worldwide (1). More than 2.8 million antibiotic-resistant infections were identified in the United States in 2019, resulting in more than 35,000 deaths (2). Prior to the development of antimicrobial resistance, bacteria frequently develop enhanced antimicrobial tolerance (3). Antimicrobial resistance is the ability of a microbe to grow in an inhibitory concentration of an antibiotic, whereas tolerance is a reduced rate of antimicrobial killing (4). Antibiotic combinations are often used to improve efficacy (5) and to prevent the emergence of antibiotic resistance (6). However, it is unclear if antibiotic combinations prevent the emergence of tolerance. On page 200 of this issue, Liu et al. (7) examine sequential Staphylococcus aureus isolates from patients treated with daptomycin plus rifampin. Although this combination of antibiotics delayed the emergence of tolerant populations, once tolerance was established, the benefits of combination therapy in preventing resistance were lost.

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