Ethics and antibiotic resistance

Abstract

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.