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Antimicrobial stewardship programmes: bedside rationing by another name?
  1. Simon Oczkowski
  1. Correspondence to Dr Simon Oczkowski, McMaster University, Juravinski Hospital Room A3-20, 711 Concession St., Hamilton, ON, Canada L8V 1C1; oczkowsj{at}


Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general. Using Norman Daniels’ Accountability for Reasonableness as a framework for evaluating resource allocation policies, I conclude that antimicrobial stewardship programmes are an ethically sound form of bedside rationing.

  • Allocation of Health Care Resources
  • Clinical Ethics

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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