[Ethical use of antibiotics in the era of multiresistance: a common good for the individual or the society?]

Abstract

Common goods refer to goods that may be used by anyone belonging to the community that has use rights over a commons and are fundamental to people's lives. Appropriate measures for safeguarding common goods should be undertaken, also for the benefit of future generations. Drugs in general, and antibiotics in particular, should be considered a common good as well. However, antibiotic use confined to the individual health benefit not only leads to less favorable outcomes for the society but also results in the development of antimicrobial resistance in the individual patient. This phenomenon is termed "tragedy of the commons" and identifies the impossibility of achieving over time the optimal treatment for each individual subject/patient. As a consequence, pursuing individual interests may lead to societal detriment. Conversely, restricting antibiotic prescriptions (e.g., avoiding overuse or misuse of last-generation antibiotics for the treatment of an infection) is not harmful for the individual, would benefit society with increased efficacy, and does not favor the emergence of antibiotic resistance. In this editorial, several suggestions as to how antibiotics should be appropriately used are provided in accordance with distributive justice principles, where individual and social interests meet.