I have been involved in the effort to improve antibiotic policy and practice for many years and a recent development may be a large help. Rather than advocating for prudence we are now recommending stewardship. Prudence – classically considered a virtue, in particular one of the four Cardinal virtues, conjures up the notion of morality. One who prescribes antibiotics poorly is immoral.
Stewardship is entirely different. It is an ethic that embodies cooperative planning and management of resources and conjures the notion of help and guidance. One who prescribes antibiotics poorly needs guidance.
I think this subtle shift in the language of antibiotic policy may help us immensely. Rather than demanding prudent use regulations that imply the stamping out of immorality we can offer frameworks for regulatory bodies to cooperatively guide prescribers. That guidance may necessarily have to include restrictive policies but with the restrictions arrived at in a more consensual fashion.
If you are interested in Antimicrobial Stewardship check out the International Society of Chemotherapy’s new Inventory of Antimicrobial Stewardship projects.