Dr Tess Johnson1
1Ethox Centre, University Of Oxford, , United Kingdom
Biography:
Dr Tess Johnson is a bioethics postdoctoral researcher based at the University of Oxford's Ethox centre, in the Nuffield Department of Population Health, having received her DPhil from Oxford's Faculty of Philosophy. Her area of focus is infectious disease ethics, with particular interests in antimicrobial resistance, emerging infectious diseases, and pathogen surveillance. She is a postdoctoral fellow on the GLIDE collaborative, a Wellcome Trust-funded research collaboration in infectious disease ethics between Johns Hopkins University and Oxford. She is also Coordinator of the Oxford Early Career Researcher Training Programme, a lecturer and supervisor for the Oxford Master of Studies in Practical Ethics, and a fellow of Reuben College.
Abstract:
Antibiotic treatment course duration has for decades been dictated by the false idea that longer courses are more effective at curing bacterial infections. Recently, the “shorter is better” movement challenged the typical antibiotic course length, building on evidence that shorter-duration antibiotic courses provide similar cure rates and fewer antibiotic-related harms compared to longer course durations for many common infections. In this paper, we examine what prescribing physicians may feel to be an ethical dilemma presented to them in their decision-making: whether they should risk under-treating a patient with an infection, or rather risk over-treating the patient. To make this decision, the physician must weigh risks to the patient including not curing their disease, increasing their risk of developing drug resistance, and exposing them to side-effects of antibiotic treatment. They must also weigh risks to public health including increasing the prevalence of drug resistance for the infection being treated or other bacterial diseases. We argue that in fact there is no ethical dilemma facing prescribers, as these considerations together clearly favour a shorter course of antibiotics in most cases. If there is a real ethical dilemma facing physicians today, it is instead between offering the shortest current evidence-based course of antibiotics, or a course that is shorter still. We conclude that more changes are needed in physicians’ antibiotic prescription behaviours in the interests of their patients and public health. Where appropriate, there should be further research on even shorter courses of antibiotics than recommended by current guidelines.