[Rational use of antibiotics as an ethical challenge].

Antibiotics resistance presents one of the major challenges for health care in the twenty-first century. This paper examines the ethical problems that arise as a result of antibiotic resistance. Two main categories of ethical problems in infectious disease control are distinguished: those that are exacerbated by antibiotics resistance, and those that are a direct result of antibiotics resistance. The second category, which is considered in greater detail in this paper, includes, among others, issues of fair distribution of effective antibiotics, if they are considered a scarce resource. Of particular interest in this context is the concept of the rational use of antibiotics, which can have different ethical implications depending on its definition: either merely the elimination of antibiotics use that is not medically indicated, or a further limitation of antibiotics use to exclude treatment that only generates small benefits. The paper examines how a more far-reaching limitation can be justified with the aid of an analogy from the field of research ethics, and finally makes concrete suggestions of ways in which normative decisions can be taken into consideration in the prescription process for antibiotics.