Gopichandran Vijayaprasad
Department of Community Medicine, ESIC Medical College and Postgraduate Institute of Medical Sciences and Research, Chennai, India.
Asian Bioeth Rev. 2022 Jan 29;14(2):183-190. doi: 10.1007/s41649-022-00202-9. eCollection 2022 Apr.
Antimicrobial resistance is an emerging global health problem. Antimicrobial stewardship interventions attempt at regulating the prescription and use of antimicrobials so that the emergence of resistance is reduced. But antimicrobial stewardship interventions have several ethical issues such as inequity in access to antimicrobials among the poor who need them more, and limitation of the autonomy of prescribers and patients. Several upstream social determinants influence susceptibility to infections, antimicrobial prescription practices, and emergence of antimicrobial resistance. Some of these social determinants impose ethical burdens on the antimicrobial stewardship interventions. Addressing these social determinants with a public health approach will help reduce antimicrobial resistance. This article argues that the social determinants approach helps reduce the ethical burdens of antimicrobial stewardship.
抗菌药物耐药性是一个新出现的全球健康问题。抗菌药物管理干预措施旨在规范抗菌药物的处方和使用，以减少耐药性的出现。但抗菌药物管理干预措施存在若干伦理问题，例如在更需要抗菌药物的贫困人口中获取抗菌药物方面存在不公平现象，以及限制了开处方者和患者的自主权。一些上游社会决定因素会影响感染易感性、抗菌药物处方行为以及抗菌药物耐药性的出现。其中一些社会决定因素给抗菌药物管理干预措施带来了伦理负担。采用公共卫生方法应对这些社会决定因素将有助于减少抗菌药物耐药性。本文认为，社会决定因素方法有助于减轻抗菌药物管理的伦理负担。
