Child Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London, UK.
Nuffield Department of Primary Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.
J Antimicrob Chemother. 2018 Sep 1;73(9):2298-2304. doi: 10.1093/jac/dky223.
Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.
抗生素耐药性对全球健康构成日益严重的威胁，但在初级保健中，抗生素经常被用于治疗急性儿童疾病，而这些疾病的临床疗效非常有限。道德哲学支持医生在治疗现有个体时考虑更广泛的社会，包括未来的患者，在抗生素在很大程度上临床无效的情况下浪费抗生素，这显然是错误的，这会损害到后代的利益。当在初级保健中治疗儿童时，医生应该有信心应用抗生素管理原则，但他们必须向家长解释这些原则。提供有关抗生素益处和危害的准确、易获取的信息是实施抗菌药物管理伦理方法和支持共同决策的关键。坦诚和诚实地说明抗生素使用的驱动因素和开具处方的原因，可能会进一步让家长的担忧得到倾听，并帮助临床医生与他们共同理解共同的目标。
