Unpacking Rational Use of Antibiotics : Policy in Medical Practice and the Medical Debate

Sammanfattning: 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.