Ethical dilemmas in antibiotic treatment: focus on the elderly

Abstract

Maximal antibiotic treatment for all patients suspected of harbouring a bacterial infection is non-viable, because it will rapidly induce resistance and exhaust this finite resource. This raises two ethical dilemmas: the question of whether we are justified in increasing the danger to a present, named, patient so as to benefit future, unknown, patients; and whether we are allowed to do so without asking the present patient for consent. Although the considerations for healthy elderly patients are similar to younger adults, the answers are complex when addressing patients with dementia, severely reduced quality of life and at end of life. We argue that a public debate on the balance between benefit to a present patient versus harm to future patients should be conducted. Such a debate should include examinations of scenarios in which antibiotic treatment does not gain any benefit in a patient with infection: at the end of life; in situations in which resistance is such that empirical antibiotic treatment seldom matches the susceptibilities of the pathogen; and in patients with no quality of life. An explicit cost-benefit model, incorporating quality of life and risk of resistance, in computerized decision support might obviate a clinician's need to deal with these difficult issues at bedside.

Bloodstream infections in older patients

“…These include challenges of antimicrobial stewardship in long-term care facilities, 51 ethical dilemmas in antibiotic treatment, 73 impact of drug interactions and polypharmacy on antimicrobial therapy, 74 the role of infectious diseases consultation in older patients. 6 Another aspect is our approach to the management of older patients, including active and invasive diagnostic work-up and treatment.…”

Ethics of Infection Control Measures for Carriers of Antimicrobial Drug–Resistant Organisms

“…Many countries have implemented measures to control AMR, including proper use of antimicrobial drugs in humans, minimization of antimicrobial drug use in animals, and prevention of further transmission of resistant microbes within the healthcare system ( 1 – 5 ). AMR raises a range of ethical questions ( 6 – 12 ). We explored ethical issues that arise in relation to carriage of antimicrobial drug–resistant organisms (hereafter called carriage).…”

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

“…Antibiotics are not benign medications and their risks need to be fully accounted for and discussed with patients. Public and scientific discourse to determine who should receive treatment would be necessary to generate ethical guidelines for antibiotic use [38,39].…”