Ethics and antibiotic resistance

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.

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

“…It is in herdsmen’s short-term interests to allow their cattle to graze on the pasture, even if they know this will lead to the pasture being depleted. This analogy is not completely accurate because, for example, the increase in individual consumption does not necessarily result in progressively greater benefits 31. However, the analogy is still useful in an initial discussion of antimicrobials, demonstrating how, if individuals act out of self-interest by using, prescribing or selling antimicrobials, then everyone, including those individuals, may be harmed in the future when antimicrobials are no longer effective.…”

“…In normative terms, this can be described as a tension between the principles of clinical ethics and those of public health ethics. Clinical ethics principles require that healthcare providers place the emphasis on the health and well-being of the individual person seeking care 31. Using the lens of clinical ethics, the problem of perpetuating AMR would appear to be secondary.…”

Perspectives on the Ethics of Antibiotic Overuse and on the Implementation of (New) Antibiotics

“…If anything, the COVID-19 pandemic situation has shown the effect that infectious diseases can have on global populations, their healthcare services and national economies. In such global health crises, individuals should consider prioritizing the long-term collective interest over their short-term individual interest and, in many cases, to prioritize the collective over the individual benefit is an ethical choice (‘tragedy of the commons’/‘principle of autonomy’) [ 2 ]. Under this aspect, citizens should understand that the overuse of antibiotics is a collective priority.…”

“…personal versus societal health and welfare—where individual interest in treating infections conflicts with the collective interest in preserving antibiotic effectiveness). To help prevent this ‘tragedy of the commons/principle of autonomy’ effective policymaking and education are vital [ 2 , 42 , 43 ]. Therefore, for AMR policy development, clinicians, healthcare researchers, commercial AMR-related businesses, social scientists, patients, farmers, environment representatives and ethicists need to work together to ensure that strategies to address global AMR take note of ethical issues in order to ensure maximum efficacy in current and future target populations [ 42 , 44 – 46 ].…”

Synergistic Antimicrobial Action of Lactoferrin-Derived Peptides and Quorum Quenching Enzymes

“…The search for new antimicrobial agents to effectively suppress the growth and development of various microbial contaminants is one of the most important tasks today in medicine, sanitation, various fields of industry and agricultural production. The current modern approach to solving these problems is considered to be the combined use of various biologically active agents that have a different substrate spectrum of antimicrobial effects and exhibit a different mechanism of inhibition against microbial contaminants [ 1 , 2 , 3 ]. Such agents include antimicrobial peptides (AMPs), which are molecules produced by living organisms as a protective “shield” against various bacterial and fungal infections [ 4 ].…”