J Med Ethics. 2017 Oct;43(10):684-687. doi: 10.1136/medethics-2015-102785. Epub 2017 Mar 15.
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general. Using Norman Daniels' Accountability for Reasonableness as a framework for evaluating resource allocation policies, I conclude that antimicrobial stewardship programmes are an ethically sound form of bedside rationing.
抗菌治疗是危重症患者治疗的基石；然而，抗生素的广泛使用导致了抗菌耐药性的增加和耐药性疾病的爆发。为了应对这一问题，许多医院已经制定了抗菌药物管理计划，以减少抗生素的不当使用。然而，抗菌药物管理计划的采用情况各不相同，因为许多临床医生担心这可能会使个别患者面临治疗失败的风险。在本文中，我认为抗菌药物管理计划确实是床边配给的一种形式，并探讨了这些计划对重症监护病房中个体患者以及一般危重症人群的风险和益处。使用诺曼·丹尼尔斯（Norman Daniels）的合理性责任作为评估资源分配政策的框架，我得出结论，抗菌药物管理计划是一种合理的床边配给形式。
