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Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a \u2018silent\u2019, chronic threat. For each of these tensions, we apply \u2018descriptive ethics\u2019 methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.<\/jats:p>","DOI":"10.1136\/bmjgh-2023-012874","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T13:40:36Z","timestamp":1712151636000},"page":"e012874","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries"],"prefix":"10.1136","volume":"9","author":[{"given":"Sunil","family":"Pokharel","sequence":"first","affiliation":[{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bipin","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess","family":"Johnson","sequence":"additional","affiliation":[{"name":"Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-3266","authenticated-orcid":false,"given":"Phaik Yeong","family":"Cheah","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,3]]},"reference":[{"key":"2025072915113446000_9.4.e012874.1","first-page":"255","article-title":"Is antimicrobial resistance a slowly emerging disaster?","volume":"8","author":"Viens","year":"2015","journal-title":"Public Health Ethics"},{"key":"2025072915113446000_9.4.e012874.2","doi-asserted-by":"publisher","DOI":"10.1111\/jlme.12270"},{"key":"2025072915113446000_9.4.e012874.3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"The Lancet"},{"key":"2025072915113446000_9.4.e012874.4","unstructured":"Institute for Health Metrics and Evaluation . 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