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. 2022 Mar 21;141(1):4-14.
doi: 10.1093/bmb/ldab030.

Ethics and antibiotic resistance

Euzebiusz Jamrozik  1   2   3 , George S Heriot  3
Affiliations

Ethics and antibiotic resistance

Euzebiusz Jamrozik et al. Br Med Bull. .

Abstract

Introduction or background: Antibiotic resistance raises ethical issues due to the severe and inequitably distributed consequences caused by individual actions and policies.

Sources of data: Synthesis of ethical, scientific and clinical literature.

Areas of agreement: Ethical analyses have focused on the moral responsibilities of patients to complete antibiotic courses, resistance as a tragedy of the commons and attempts to limit use through antibiotic stewardship.

Areas of controversy: Each of these analyses has significant limitations and can result in self-defeating or overly narrow implications for policy.

Growing points: More complex analyses focus on ethical implications of ubiquitous asymptomatic carriage of resistant bacteria, non-linear outcomes within and between patients over time and global variation in resistant disease burdens.

Areas timely for developing research: Neglected topics include the harms of antibiotic use, including off-target effects on the human microbiome, and the lack of evidence guiding most antibiotic prescription decisions.

Keywords: antimicrobial resistance; bioethics; drug resistance; justice; stewardship; tragedy of the commons.

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Figures

Fig. 1
Fig. 1
Global hierarchy of policy approaches for antibiotic resistance.
See this image and copyright information in PMC

References

    1. The Review on Antimicrobial Resistance . Tackling a crisis for the health and wealth of nations. In: Chaired by. In: O’Neill J (ed.). The Review on Antimicrobial Resistance. December, 2014. https://www.sciencedirect.com/science/article/pii/S0140673621027240
    1. Jamrozik E, Selgelid MJ. Drug-resistant infection: causes, consequences, and responses. In: Jamrozik E, Selgelid MJ (eds.). Ethics and Drug Resistance: Collective Responsibility for Global Public Health. Public Health Ethics Analysis. Cham, Switzerland: Springer, 2020
    1. Littmann J, Viens AM. The ethical significance of antimicrobial resistance. Public Health Ethics 2015;8:209–24. - PMC - PubMed
    1. Nguyen B, Fox GJ, Mason PH, Denholm JT. Preventive therapy for multidrug resistant tuberculosis: an ethical imperative with ethical barriers to implementation? In: Jamrozik E, Selgelid MJ (eds.). Ethics and Drug Resistance: Collective Responsibility for Global Public Health. Public Health Ethics Analysis. Cham, Switzerland: Springer, 2020
    1. Haire B. Providing universal access while avoiding antiretroviral resistance: ethical tensions in HIV treatment. In: Jamrozik E, Selgelid M (eds.). Ethics and Drug Resistance: Collective Responsibility for Global Public Health. Cham: Springer International Publishing, 2020,37–54

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