{
  "abstract": "Antibiotic resistance is often foreseeable, yet antibiotic development remains largely reactive: new agents are commonly evaluated only once existing standards begin to fail clinically. This creates an ethical dilemma for ‘anticipatory antibiotics’, therapies intended to preserve options against future resistant strains that may be marginally less effective than today’s standard of care for current infections. Using a hypothetical case (novelotic vs oldamycin), I argue that when resistance is credibly foreseeable, clinical research ethics should permit, and in some cases require, anticipatory active-control trials that balance bounded present risks against preventable future harms. Such trials are ethically acceptable only if they include strong protections for current participants, including intensive monitoring, independent oversight with stopping rules and prompt rescue therapy, alongside highly transparent informed consent that candidly addresses the trial’s future-oriented benefits. A prespecified, clinically justified non-inferiority margin further protects future patients by preventing clinically meaningful losses in efficacy from being misclassified as acceptable. Finally, I propose a threshold framework, based on empirical markers such as rising surveillance resistance rates or transferable resistance genes, to guide when anticipatory trials should be initiated before crisis conditions emerge.",
  "authors": [
    {
      "affiliations": [
        "Department of Biology, University of Rochester, Rochester, New York, USA"
      ],
      "name": "Aashay Mardikar"
    }
  ],
  "title": "Anticipatory antibiotics as preventive medicine: the ethics of proactive clinical trials",
  "uid": "72314e8d-3739-5ae4-b806-75f6aa6eb8ac"
}