Abstract
IntroductionBioethics in the use of antibiotics creates spaces that integrate the biological (Bios) with human values (Ethics), before the decision is made to prescribe an antibiotic in a patient with infection that requires it when faced with an alert situation such as bacterial resistance. ObjectiveTo review, and reflect on Bioethics in the use of antibiotics, through a dialogue between biology and ethics in Intensive care. MethodologyThe medical literature was reviewed, and an analysis performed on the biological aspects; use of antibiotics and bacterial resistance (Bios), as well as the human values; dignified care, principle of autonomy, end of life decisions. Conflict of interests at the time of prescription (Ethics), of the medical act. ResultBiological aspects (Bios). The highest use of third-generation cephalosporin antibiotics, carbapenems and vancomycin, at hospital level is carried out in intensive care. The bacteria Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus, are the cause of hospital outbreaks. The management in the control of antibiotics ‘antimicrobial stewardship control’ is the current form of institutional control on the multidisciplinary use of antibiotics by integrating the microbiologist, pharmacologist, and infectious agent. Human values (Ethics). To have all the necessary means to avoid institutional infections (dignified and humane care). Know the flora that colonises and infects, and the level of resistance to antibiotics (Principle of truthfulness and Justice). Empirical treatment of infections established as a norm (Principle of Beneficence). Respect the patient's decision after being informed of antimicrobial therapy (Principle of autonomy). Re-think the therapeutic objectives of the patient in sepsis-septic shock in multiple organ failure (End of Life Situation). Prescription of antibiotics for empirical treatment, ‘brand or generic’ (Ethical dilemma and conflict of interests). Statistical analysis. The values presented in the article obey those provided by the analysis of the medical literature. CommentSpaces must be created that integrate the biological aspects (Bios) with human values (ethics), before the decision to prescribe an antibiotic and due to the warning situation, such as bacterial resistance. The medical decisions made on the prescription of antibiotics to patients today have an influence on the patients who will also need them in the future.
Published Version
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