Optimizing antibiotic prescribing : collective approaches to managing a common-pool resource
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Background: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR
has been characterized as a social dilemma. A familiar version describes the situation in which a collective
resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma
arises because individuals are motivated to maximize individual payoffs, although the collective outcome
is worse if all act in this way.
Objectives: We aim to outline the implications for antimicrobial stewardship of characterizing antibiotic
overuse as a social dilemma.
Sources: We conducted a narrative review of the literature on interventions to promote the conservation
of resources in social dilemmas.
Content: The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence
of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships
inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour
and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1)
establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the
problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use
social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and
(7) provide conflict resolution mechanisms.
Implications: We conclude that this theoretic analysis of antibiotic stewardship could make the problem
of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.
Description
CITATION: Tarrant, C., et al. 2019. Optimizing antibiotic prescribing : collective approaches to managing a common-pool resource. Clinical Microbiology and Infection, 25(11):1356-1363, doi:10.1016/j.cmi.2019.03.008.
The original publication is available at https://www.clinicalmicrobiologyandinfection.com/
The original publication is available at https://www.clinicalmicrobiologyandinfection.com/
Keywords
Antibiotic -- Prescribing, Antimicrobial agents, Resistance to drugs
Citation
Tarrant, C., et al. 2019. Optimizing antibiotic prescribing : collective approaches to managing a common-pool resource. Clinical Microbiology and Infection, 25(11):1356-1363, doi:10.1016/j.cmi.2019.03.008