Alternative therapeutics for infectious diseases is a top priority, but what infections should be the primary targets? At present there is a focus on therapies for severe infections, for which effective treatment is most needed, but these infections are hard to manage, and progress has been limited. Here, we explore a different approach. Applying an evolutionary perspective to a review of antibiotic prescription studies, we identify infections that likely make a large contribution to resistance evolution across multiple taxa but are clinically mild and thus present easier targets for therapeutics development. Alternative therapeutics for these infections, we argue, would save lives indirectly by preserving the high efficacy of existing antibiotics for the patients who need them the most.

传染病的替代疗法是重中之重，但是哪些感染应成为主要目标？当前，针对严重感染的疗法是关注的，最需要有效的治疗方法，但是这些感染难以控制，并且进展有限。在这里，我们探索了一种不同的方法。将进化的观点应用到抗生素处方研究的回顾中，我们确定了可能在多个分类单元中对耐药性进化做出重大贡献但在临床上较轻的感染，因此为治疗方法的开发提供了更容易的目标。我们认为，针对这些感染的替代疗法可通过为最需要抗生素的患者保留现有抗生素的高疗效而间接挽救生命。