C Tarrant1, A M Colman2, E Chattoe-Brown3, D R Jenkins4, S Mehtar5, N Perera4, E M Krockow6. 1. Department of Health Sciences, University of Leicester, Leicester, UK. Electronic address: ccp3@le.ac.uk. 2. Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK. 3. School of Media, Communication and Sociology, University of Leicester, Leicester, UK. 4. Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK. 5. Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. 6. Department of Health Sciences, University of Leicester, Leicester, UK.
Abstract
BACKGROUND: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized 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 maximize 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 characterizing 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 optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.
BACKGROUND: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized 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 maximize 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 characterizing 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 optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.
Authors: Peter Taber; Charlene Weir; Jorie M Butler; Christopher J Graber; Makoto M Jones; Karl Madaras-Kelly; Yue Zhang; Ann F Chou; Matthew H Samore; Matthew Bidwell Goetz; Peter A Glassman Journal: Am J Infect Control Date: 2021-01-27 Impact factor: 2.918
Authors: Fredrik Carlsson; Gunnar Jacobsson; Sverker C Jagers; Elina Lampi; Felicia Robertson; Björn Rönnerstrand Journal: SSM Popul Health Date: 2019-10-22
Authors: Eva M Krockow; R H J M Kurvers; S M Herzog; J E Kämmer; R A Hamilton; N Thilly; G Macheda; C Pulcini Journal: Sci Rep Date: 2020-11-02 Impact factor: 4.379
Authors: Carolyn Tarrant; Eva M Krockow; W M I Dilini Nakkawita; Michele Bolscher; Andrew M Colman; Edmund Chattoe-Brown; Nelun Perera; Shaheen Mehtar; David R Jenkins Journal: Front Sociol Date: 2020-02-20
Authors: Lok Hang Wong; Evonne Tay; Shi Thong Heng; Huiling Guo; Andrea Lay Hoon Kwa; Tat Ming Ng; Shimin Jasmine Chung; Jyoti Somani; David Chien Boon Lye; Angela Chow Journal: Antibiotics (Basel) Date: 2021-11-24