Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children
In a paper published in the Journal of Antimicrobial Chemotherapy, we discuss key issues in applying an evidence-based approach to the prescribing of antibiotics to children.
Antimicrobial resistance is a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations.
Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.
All this requires adequate time in the consultation; for both a thorough clinical assessment of the child; and a full discussion with the parents about the appropriateness, benefits and risks of antibiotic treatment.