Mathematical modeling of cholera dynamics in the presence of antimicrobial utilization strategy

Antimicrobial resistance poses a significant threat to public health, particularly in cholera treatment. The emergence of antibiotic resistance, coupled with the sharp decline in pharmaceutical companies developing new cholera antibiotics, is a cause for concern. We formulate a multidrug-resistant (MDR) cholera epidemic model that incorporates a stage-switching strategy between two antibiotics to reduce the magnitude of resistance. The model is analyzed mathematically, and sensitivity analysis of the reproduction number is performed using sub-reproduction numbers. Stability analysis of the cholera-sensitive-only and cholera-resistant-only equilibria is investigated using Centre Manifold Theory. The model is calibrated through Markov Chain Monte Carlo simulations in Stan, showing stability at equilibrium points, which is further verified through numerical simulations. The simulations demonstrate an inverse relationship between the number of MDR cholera cases and the number of individuals receiving second-line treatment for cholera. This study suggests that the correct use of antibiotics can effectively manage the emergence of antimicrobial resistance. From a public health policy perspective, these findings emphasize the importance of antibiotic stewardship programs and the need for policies that promote the responsible use of existing antibiotics while encouraging the development of new treatment options. Such measures could help mitigate the global burden of MDR cholera and prevent further escalation of resistance.