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Harmless, friendly and lethal: antibiotic misuse in relation to the unpredictable bacterium Group A streptococcus
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology. (Cultural Matters Group, Welfare and Life Course Research Group)ORCID iD: 0000-0001-9959-3245
2018 (English)In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 40, no 7, p. 1127-1141Article in journal (Refereed) Published
Abstract [en]

Evidence‐based treatment guidelines for managing infections in health care are promoted as tools to prevent unnecessary use of antibiotics. Antibiotic misuse has been examined as regards the doctor‐patient relation and the social context of medical practice. Less attention has been paid to how the very conceptualisation of human‐microbial relations may influence understandings of antibiotic misuse. The article examines a medical controversy concerning guidelines for managing throat infection and antibiotic treatment in Sweden. It demonstrates how this controversy unfolds around two different ways of relating to a specific bacterium – Group A Streptococcus. The analysis shows how two ‘microbiopolitics’, involving different understandings of human‐microbial relations, are created in the controversy and how different antibiotic prescribing practices are justified. By focusing on Group A Streptococcus, which is commonly observed, but also unpredictable and potentially dangerous, the article provides new insights into the relations between bacteria, humans and policy in an age of antimicrobial resistance. It argues, in particular, that the definition of antibiotic misuse is unstable and consequently that policy measures aimed at reducing misuse must be related to how specific infections and bacteria are conceptualised in the actual context the policy addresses.

Place, publisher, year, edition, pages
2018. Vol. 40, no 7, p. 1127-1141
Keywords [en]
Antimicrobial resistance, Evidence-based medicine, Human-microbial relations, Throat infection
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Sociology
Identifiers
URN: urn:nbn:se:uu:diva-358018DOI: 10.1111/1467-9566.12742ISI: 000444080100002PubMedID: 29707795OAI: oai:DiVA.org:uu-358018DiVA, id: diva2:1241353
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2018-11-19Bibliographically approved
In thesis
1. Unpacking Rational Use of Antibiotics: Policy in Medical Practice and the Medical Debate
Open this publication in new window or tab >>Unpacking Rational Use of Antibiotics: Policy in Medical Practice and the Medical Debate
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rational use of antibiotics–using antibiotics only when needed and in the right way–is a prioritized goal in policy aimed at preventing antimicrobial resistance. A vast body of research is devoted to understanding why unnecessary antibiotics are prescribed. However, this research tends to treat the definition of rational prescribing as an unproblematic fact, which is given by evidence.

The thesis aims to sociologically unpack rational use of antibiotics as medical knowledge and a policy goal. One study examines how rational use of antibiotics in health care was established as a crucial part of AMR prevention in Sweden, and three studies, drawing on different materials, look at how rational antibiotic use for everyday infections is negotiated and performed in medical practice and the medical debate in Sweden. The thesis makes theoretic use of material semiotics and critical policy studies, which enables examination of how medical knowledge, medical objects and policy are performed in webs of relations between human and non-human actors.

The studies show that rational use of antibiotics for everyday infections is characterized by uncertainties and tensions. These cannot be reduced to medical professionals’ ignorance, or to how non-medical factors influence medical practice. This implies that social factors are not enough to explain why medical professionals dismiss specific policy definitions of medically appropriate prescribing. Instead, the uncertainties and tensions characterizing rational antibiotic prescribing can be traced to the complex and contingent nature of medical knowledge and medical objects, as well as to the potentially conflicting risks that antibiotic prescribing involves. As a consequence, deviance from, or critique of, a specific definition of rational use of antibiotics may constitute a performance of rational use of antibiotics as a policy goal. In medical practice and the medical debate, rational use of antibiotics as a policy goal can draw on and work with mutable medical knowledge and objects, as well as conflicting medical risks. It is concluded that sociologists need to continue entering the seemingly pure medical sphere to critically investigate policy and policy goals that draw on medical knowledge and that, as such, appear to be neutral and undisputable.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 158
Keywords
Antibiotics, Policy, Medical Sociology, Actor-Network Theory, Human-microbial relations, Antimicrobial Resistance, Everyday Infections, Material semiotics, Medical sociology, Medical objects, Medical technologies, Medical knowledge
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:uu:diva-358022 (URN)978-91-513-0421-2 (ISBN)
Public defence
2018-10-12, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-20 Created: 2018-08-23 Last updated: 2018-10-02

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Gröndal, Hedvig

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