Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/44546
Title: Optimising antibiotic prescribing: Collective approaches to managing a common-pool resource.
Authors: Tarrant, C
Colman, AM
Chattoe-Brown, E
Jenkins, DR
Mehtar, S
Perera, N
Krockow, EM
First Published: 23-Mar-2019
Publisher: Elsevier for European Society of Clinical Microbiology and Infectious Diseases
Citation: Clinical Microbiology and Infection, 2019
Abstract: BACKGROUND: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterised as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximise individual payoffs, although the collective outcome is worse if all act in this way. OBJECTIVES: We aim to outline the implications for antimicrobial stewardship of characterising antibiotic overuse as a social dilemma. SOURCES: We conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas. CONTENT: The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms. IMPLICATIONS: We conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimising antibiotic prescribing more tractable, providing a theory base for intervention development.
DOI Link: 10.1016/j.cmi.2019.03.008
eISSN: 1469-0691
Links: https://www.sciencedirect.com/science/article/pii/S1198743X19301107?via%3Dihub
http://hdl.handle.net/2381/44546
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Appears in Collections:Published Articles, Dept. of Health Sciences

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