Q3 Tragedy of the commons and antimicrobial stewardship

Question 3 of our JMO pre-test survey asked about the aims of antimicrobial stewardship (yes, better ‘antimicrobial’ than ‘antibiotic’- antiviral, antifungal, antiparasitic resistance are issues as well). We gave you three options  and all except one responded with the correct answer – all three!  The order is important – treatment of the individual patient comes first:

  1. Optimise the effectiveness of individual patient antimicrobial treatment for infection (implies that the right patients are identified for treatment and that correct treatment and follow-up occurs)
  2. Improve patient safety by reducing unintended consequences of antimicrobial treatment (implies that we know our guidelines,  our drugs and our patients well)
  3.  Ecology – reduce antimicrobial resistance by reducing antibiotic selective pressure on micro-organisms (selective pressure arises from any a/m exposure;  prolonged courses and/or broader spectrum agents worse ; unnecessary use also critical –  humans who have not ‘earned’ their antibiotics,  and many situations across agriculture and food production)

The global antimicrobial resistance dilemma we face is truly a ‘Tragedy of the Commons‘ :

“A dilemma arising from the situation in which multiple individuals, acting independently and rationally consulting their own self-interest, will ultimately deplete a shared limited resource, even when it is clear that it is not in anyone’s long-term interest for this to happen.”

Cooperative stewardship of the resource required. Technical solutions (e.g. finding a new antibiotic) alone won’t solve it!

References

One comment

  1. […] a read of this posting to learn more about the three elements of AMS and the Tragedy of the […]

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