University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, United Kingdom of Great Britain and Northern Ireland.
Bioethics. 2019 Sep;33(7):756-765. doi: 10.1111/bioe.12604. Epub 2019 Jul 2.
Antimicrobial resistance (AMR) describes the evolution of treatment-resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over-prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures-South Africa, Sri Lanka and the United Kingdom. Then we discuss how country-specific factors impact on the prominence of various ethical dimensions of the dilemma (visibility and moral equality of future generations; Rule of Rescue; prescribing autonomy and conflicts of interest; consensus on collective action). We conclude that a nuanced understanding of national prescribing dilemmas is critical to inform the design of effective stewardship approaches.
抗菌药物耐药性（AMR）描述了具有治疗抗性的病原体的进化，这可能对人类医学产生灾难性的后果。AMR 是由抗生素的过度处方驱动的，通过考虑医生所面临困境的伦理维度，可以减少 AMR。这种困境涉及平衡当前和未来患者明显对立的利益，以及不同国家独特的背景因素，这些因素可能会改变核心困境。我们描述了三个具有不同经济背景和文化的示例国家：南非、斯里兰卡和英国。然后，我们讨论了国家特定因素如何影响困境的各种伦理维度的突出程度（可见性和未来几代人的道德平等；救援规则；处方自主权和利益冲突；对集体行动的共识）。我们得出的结论是，对国家处方困境的细致理解对于为有效的管理方法的设计提供信息至关重要。
