J. Greshm^{* *}Correspondence: J. Greshm, Department of Medicine, University of Texas Southwestern, Dallas, Texas, United States, Email:

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1. Description

Use of antibiotics is a key factor in the development of organisms that are resistant to drugs. The problem with antibiotic use often referred to as “the tragedy of the commons” is that both proper and improper use of antibiotics fosters resistance. A systematic study and analysis has demonstrated that prescribing antibiotics increases the likelihood of resistance in specific patients. Restrictions on antibiotic usage still play a significant role, even though investments in the research of new medicines and in infection control can help lessen the impact of resistance. Making decisions about antibiotic therapy should be guided by a balance between short-term, individual gain and longer-term, community benefit. It is stated that requesting doctors not to give antibiotics in cases when they are unnecessary does not generate any unethical concerns.

Yet, limiting the use of therapeutically justified antibiotics creates an ethical conundrum where the individual need to treat illnesses is weighed against the group requirement to maintain antibiotic effectiveness. A greater knowledge of how antibiotic use affects both individual patients and society as a whole is necessary to strike the correct balance. In response to the increased antibiotic use in hospitals around the world, Antimicrobial Stewardship (AMS) has been established as a crucial strategy. AMS frequently aims to limit unnecessary antibiotic use. Decision making about antibiotic use is still not ideal despite mounting evidence of AMS impact. Worldwide, about half of hospital patients received ineffective antibiotic treatment.

Doctors often prefer broad spectrum antibiotics, particularly when the source of the infection is unknown and there is a lack of microbiological proof. Simply put, the availability of recent, locally pertinent surveillance data, prescription criteria, and permission processes determine antibiotic prescribing in hospitals. Yet, the majority of research on hospital antibiotic prescribing patterns has been done in high-income nations. The complexity of behaviour change in prescribing practises, which is driven by mutually interdependent internal (knowledge and attitudes) and extrinsic (patient-and healthcare system related) factors, was first demonstrated in a qualitative literature review. Recent research showed that prescribers are overly dependent on antibiotics and broad-spectrum antibiotics for some perceived short term benefits, such as speedy healing, low cost, low risk, and low cognitive effort in patients. Despite being aware of the problem of rising resistance, prescribers frequently argued that reducing antibiotic use in hospitals would be ineffective because the primary causes are outside of hospital settings, such as the uncontrolled use of antibiotics in the community and the quality of medications. The attempts to alter behaviour in hospital settings in order to address the issue of antibiotic resistance may be hampered by this psychology of externalising responsibility. Also, limited research from low and Middle income Countries (LMICs) underlined the idea that clinicians felt the need to administer broad spectrum antibiotics for infection prevention due to poor sanitation and infection control in these settings. A recent review also showed that interventions in LMICs that included diverse tactics were more successful at altering behaviour, and that future interventions should take into account how structural and contextual factors affect people’s behaviour. Hence, more information is required to fully understand these features and develop suitable interventions to support the best practises for prescription antibiotics in hospitals in LMIC settings.