Zusammenfassung
Antibiotikaresistenz stellt eine der größten Herausforderungen für die Gesundheitsversorgung des 21. Jahrhunderts dar. Dieser Artikel beleuchtet die ethischen Probleme, die als Resultat der Antibiotikaresistenz entstehen. Dabei muss zwischen zwei Kategorien von ethischen Problemen im Infektionsschutz unterschieden werden: Problemen, die durch Antibiotikaresistenz verstärkt werden, und Problemen, die überhaupt erst durch Antibiotikaresistenz entstehen. In die zweite Kategorie, die in diesem Artikel näher betrachtet wird, fallen unter anderem Fragen der gerechten Verteilung von effektiven Antibiotika, wenn diese als knappe Ressource betrachtet werden. Hierbei ist vor allem das Konzept des rationalen Antibiotikagebrauchs von Bedeutung, das je nach Auslegung entweder nur eine Eliminierung des medizinisch nicht indizierten Antibiotikaeinsatzes oder aber eine weitergehende Einschränkung des Verbrauchs nach sich zieht, bei dem auch Therapien mit geringem Nutzen ausgeschlossen werden. Der Artikel untersucht, wie eine solche weitergehende Einschränkung mithilfe einer Analogie aus der Forschungsethik begründet werden kann und macht anschließend konkrete Vorschläge, wie normative Entscheidungen im Verschreibungsprozess für Antibiotika berücksichtigt werden sollten.
Abstract
Antibiotics resistance presents one of the major challenges for health care in the twenty-first century. This paper examines the ethical problems that arise as a result of antibiotic resistance. Two main categories of ethical problems in infectious disease control are distinguished: those that are exacerbated by antibiotics resistance, and those that are a direct result of antibiotics resistance. The second category, which is considered in greater detail in this paper, includes, among others, issues of fair distribution of effective antibiotics, if they are considered a scarce resource. Of particular interest in this context is the concept of the rational use of antibiotics, which can have different ethical implications depending on its definition: either merely the elimination of antibiotics use that is not medically indicated, or a further limitation of antibiotics use to exclude treatment that only generates small benefits. The paper examines how a more far-reaching limitation can be justified with the aid of an analogy from the field of research ethics, and finally makes concrete suggestions of ways in which normative decisions can be taken into consideration in the prescription process for antibiotics.
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J. Littmann und A. Buyx geben an, dass kein Interessenkonflikt besteht.
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Littmann, J., Buyx, A. Rationaler Antibiotikaeinsatz als ethische Herausforderung. Bundesgesundheitsbl 61, 589–594 (2018). https://doi.org/10.1007/s00103-018-2716-0
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DOI: https://doi.org/10.1007/s00103-018-2716-0