Этические и юридические аспекты назначения антибактериальных препаратов резерва

Abstract

The article explains what an antibacterial reserve preparation means. It has been shown that the drug belonging to the group is determined by its pharmacological properties only such as a clinically significant (sufficient for empirical application) activity in relation to Pseudomonas aeruginosa or nosocomial (methicillin-resistant) strains of Staphylococcus aureus. It allows to differentiate between two categories of reserve antibiotics, which exert an anti-Gram-negative and anti-Gram-positive activity. There is an exhaustive list of preparations included into each group and available in the Russian market. Meanwhile, no drugs that correspond to inclusion requirements for both groups are available. Possible conflicts that occur during clinical application of antibacterial reserve drugs are comprehensively analyzed. It is based on divergence of interests of a patient and the patient’s representatives, treating physician, management of the clinic, hospital epidemiologists and manufacturers of reserve generics. Economic and general biological (selection of drug-resistant strains in extensively wide application) arguments commonly contradict the legal (compliance with clinical recommendations), moral and ethical (independence of aid quality from the patient’s prognosis) standards. The Legislator’s position in relation to the issue has been reviewed. Imperfect regularity framework and insufficient legal safety of a doctor make it possible to resolve conflicts through concessions and agreements including reserve antibiotics prescribed as per conditionally social indications.