The Evolution of Antibiotic Resistance: Insight into the Roles
of Molecular Mechanisms of Resistance and Treatment Context
Abstract: The widespread use of antibiotics has markedly
improved public health over the last 60 years. However, the
efficacy of antibiotic treatment is rapidly decreasing as a
result of the continual spread of antibiotic resistance in
pathogen populations. The evolution of antibiotic resistance is
an amazingly simple example of adaptation by natural selection,
and there is growing interest among evolutionary biologists in
using evolutionary principles to help understand and combat the
spread of resistance in pathogen populations. In this article,
we review recent progress in our understanding of the underlying
evolutionary forces that drive antibiotic resistance. Recent
work has shown that both the mechanisms of antibiotic action and
resistance, as well as the treatment context in which resistance
evolves, influence the evolution of resistance in predictable
ways. We argue that developin