Antibiotic prescribing behavior among physicians: ethical challenges in resource-poor settings
Ethics, Antibiotics, Antimicrobial Resistance
Prescribing antibiotics to patients represents an ethical dilemma for physicians since the current health needs of the patients have to be balanced with concerns for long term containment of antimicrobial resistance in the community. Overuse of antibiotics is a major pathway for development of antimicrobial resistance. In resource-poor settings a complex social reality can influence antibiotic prescribing behavior among physicians which apparently violates the conventional biomedical ethics principles especially beneficence and justice. These social factors include patient socioeconomic class, patient demand for antibiotics, competition among practitioners and conflict of interest arising from the physician’s social relationship with his/her patient. Current approaches for combating antimicrobial resistance in the developing countries are inadequate in factoring and dealing with those irrational prescription practices which are driven predominantly by subtle violation of medical ethics as opposed to blatant economic and professional profiteering.
2. Leibovici L, Paul M, Ezra O. Ethical dilemmas in antibiotic treatment. J Antimicrob Chemother. 2012;67(1):12–6.
3. Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet.2016; 7(10014):168-75.
4. Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet InfectDis. 2013; 13(12):1057-98.
5. Leibovici L, Paul M. Ethical dilemmas in antibiotic treatment: Focus on the elderly. Clin Microbiol Infect.2015; 21(1): 27–9.
6. Kotwani A, Wattal C, Katewa S, Joshic PC, Holloway K. Factors influencing primary care physicians toprescribe antibiotics in Delhi India. Fam Pract. 2010; 27(6): 684–90.
7. Stubbe M, Dowell A, Plumridge E, Mac donald L, Dew K. Prescribing dilemma: do our GPs say one thingwhile doing another? New Zealand Pharmacy Journal. 2008; 28(3): 28–30.
8. Balch A, Schoen JH, MS, Patel PK. Should physicians consider the environmental effects of prescribing antibiotics? AMA Journal of Ethics. 2017; 19(10):957–65.
9. Chandy SJ, Mathai E, Thomas K, Faruqui AR, Holloway K, Lundborg CS. Antibiotic use and resistance:perceptions and ethical challenges among doctors, pharmacists and the public in Vellore, South India. IndianJ Med Ethics. 2013; 10(1): 20–7.
10. Korenman SG, Bramstedt KA. Your spouse/partner gets a skin infection and needs antibiotics: is it ethical foryou to prescribe for them? Yes: It is ethical to treat short-term, minor problems. West J Med. 2000; 173(6):364.
11. Hoque R, Mostafa A, Haque M. Intern doctors’ views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh. Ther Clin Risk Manag. 2015; 11: 1177–85.
12. Kotwani A, Chaudhury RR, HollowayK. Antibiotic-prescribing practices of primary care prescribers for acute diarrhea in New Delhi, India. Value Health. 2012; 15(1 Suppl):S116-9.