Antibiotic policies

Abstract

The increasing number of antibiotics, and a growing awareness of the problems arising from their use, have stimulated many attempts to develop policies to control and improve their usage. Despite numerous attempts, there has been a notable lack of success in developing a policy which has been widely accepted. The main reason for this has been the conflict between the medical ethic that the individual patient should receive the treatment most appropriate to his particular needs and the limitation of prescribing freedom imposed by policies, the main objective of which has been to protect the community as a whole from the emergence of drug-resistant bacteria. A secondary reason for this failure has been the excessive regimentation of prescribing imposed by policies which had, as their main objective, the application of rules to what was assumed to be laissez-faire chaos and thus inherently bad prescribing practice. Clinical experience has, however, frequently demonstrated the limitation of such policies and, as a result, they rapidly lost credibility. It is important, therefore, in developing an antibiotic policy to consider in detail the reasons for such a policy and to design it to achieve only specific and attainable objectives. This must be done with due consideration for the particular needs of the individual patient. Now that considerably more antibacterial agents are available, and there is an adequate choice, it may be possible to suggest, at least, the basic structure of such an antibiotic policy. However, first it is necessary to consider in detail the objectives and the limitations of antibiotic policies.