Antimicrobial resistance and antimicrobial stewardship programmes: benefiting the patient or the population?

A selection of abstracts of clinically relevant papers from other journals.

The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

'...bedside rationing of antimicrobials is 'fair and ethically sound' even if it doesn't promote the short-term best medical interest of the individual patients'.

Main

Giubilini A. J Med Ethics 2017;43: 653–654

The readers of this section of the Br Dent J have been questioned as to how society can tackle the abuse of antibiotics;. whether it is usage fees to restrict non-human use of antibiotic growth promoters (N Engl J Med 2013;369: 2474–2476), the discovery of new antibiotics from soils of a 'grassy field in Maine' (Nature 2015;517: 455–459), legislation that supports antimicrobial stewardship (Lancet Infect Dis 2015;26: 377–378) or merely discontinuing a course of antibiotics when symptoms resolve (BMJ 2017;358: j3418). But is the antibiotic crisis just more fake news (Lancet Infect Dis 2017;17: 473–474)? The author of this Editorial, who is a distinguished bioethicist, is persuaded by the argument that antimicrobial resistance is a 'slowly emerging disaster'. He draws an analogy with 'the tragedy of the commons'. He cites Simon Oczkowski's article in this issue of the same journal (J Med Ethics 2017; 43: 684–687) that bedside rationing is 'fair and ethically sound' if the clinician, 'behind a Rawlsian veil ignorance', can weigh up the competing needs of society and prescribing an antibiotic for their patient.