An integrative model finds comparable contributions to drug resistance from poor drug adherence and adapting bacteria

Antibiotic resistance is a compound effect of several factors in the infection to healing cycle, from molecular factors such as mutation rate of bacteria to habitual behaviors such as adherence to a prescribed drug. Usually each of these factors is modeled separately from biochemistry, evolutionary biology or population health perspectives. To develop an understanding for the drug resistance at a population level, which is of high global significance, it is important to weigh all these factors in an integrated model. We develop RASAID, a model for resistance considering bacterial adaptation, infection spread, population adherence, immunity, and drug dosage. We apply the model to antibiotic resistance in the spread of resistant strains of Streptococcus Pneumoniae (Sp) in a finite community. We analyze the contributions from several factors to resistance, with a goal towards asking how important is the pursuit of newer drug developments relative to improving the awareness about the good practices in drug usage.