Abstract
Ethical behavior encompasses actions that benefit both self and society. This means that tackling antimicrobial resistance (AMR) becomes an ethical obligation, because the prospect of declining anti-infectives affects everyone. Without preventive action, loss of drugs that have saved lives over the past century, will condemn ourselves, people we know, and people we don’t know, to unacceptable risk of untreatable infection. Policies aimed at extending antimicrobial life should be considered within an ethical framework, in order to balance the choice, range, and quality of drugs against stewardship activities. Conserving availability and effectiveness for future use should not compromise today’s patients. Practices such as antimicrobial prophylaxis for healthy people ‘at risk’ should receive full debate. There are additional ethical considerations for AMR involving veterinary care, agriculture, and relevant bio-industries. Restrictions for farmers potentially threaten the quality and quantity of food production with economic consequences. Antibiotics for companion animals do not necessarily spare those used for humans. While low-income countries cannot afford much-needed drugs, pharmaceutical companies are reluctant to develop novel agents for short-term return only. Public demand encourages over-the-counter, internet, black market, and counterfeit drugs, all of which compromise international control. Prescribers themselves require educational support to balance therapeutic choice against collateral damage to both body and environment. Predicted mortality due to AMR provides justification for international co-operation, commitment and investment to support surveillance and stewardship along with development of novel antimicrobial drugs. Ethical arguments for, and against, control of antimicrobial resistance strategies are presented and discussed in this review.
Highlights
Antimicrobial agents play a huge role in medical practice
This review aims to introduce and discuss some of the most important ethical dilemmas associated with antimicrobial resistance (AMR) and its control, including national and international responsibilities, pharmaceutical companies, prescribing, education, advertising, veterinary and agricultural practices, infection control, and patient behavior
Many of the activities described in this article would forestall the spread of AMR to a greater or lesser extent, provided they are implemented and upheld by the correct authorities
Summary
Antimicrobial agents play a huge role in medical practice. The facility for healthcare services to reliably cure the infected patient has saved countless lives over the last century. Medicine reached a pivotal point in the 1960’s with the introduction of multiple agents, which could seemingly treat any infection. This received due comment from US Surgeon General who infamously declared that the threat from infection had been relegated to the past (Infectious Diseases Society of America [IDSA] et al, 2011). Nowadays, increasing resistance is seen as a major problem, since there have been diminishing numbers of novel antibiotics approved since the late 1970’s (Infectious Diseases Society of America [IDSA] et al, 2011). It appears that the microbial propensity to develop resistance is occurring much faster than man’s ability to develop new agents
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