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Forsigtig antibiotikabrug i Norden. Hvordan kan den fremmes? Fokus er antibiotikas påvirkning af tarmfloraen
Nordic Council of Ministers, Nordic School of Public Health NHV.
2014 (Danish)Independent thesis Advanced level (degree of Master (Two Years))Student thesisAlternative title
Antibiotics and intestinal flora: improving the prudent antibiotic use in Scandinavia (English)
Abstract [da]

BAGGRUND: Antibiotikaresistens udgørentrussel mod folkesundheden. Antibiotikabruger hoveddrivekraften bag resistensudviklingen.Restriktiv antibiotikabrugi overens-stemmelse med de gældende retningslinjerer derfornødvendig. Tarmfloraenpåvirkes af antibiotika oghar betydning for helbredet.Den salutogene teori er et veletableretkonceptindenfor Public Health. Oplevelse af sammenhæng (OAS)udgør et centralt koncept indenfor den salutogene teori, afspejler en persons syn på livet og kapacitet til at respondere på stressfyldte situationerog indeholder komponenterne begribelighed, håndterbarhed og meningsfuldhed.OASudgøret værdifuldt værktøj ved problemstillinger, hvor målet er ”compliant”adfærd.Det kunne tænkes,at hvis befolkningen og lægerne manglede OAS vedrestriktiv antibiotikabrug, kunne dette bidrage til at derescompliance til retningslinjerne, der anbefaler forsigtig antibiotikabrug ikke var optimal.

FORMÅL: At formulere forslag til, hvordan forsigtig antibiotikabrug kunne fremmes ved at optimere OAS. Baggrundener litteratur, der belyser (i) befolkningens og lægernesholdninger overfor antibiotika og antibiotikaresistens i Norden og (ii) antibiotikas påvirkning af tarmfloraen og mulige helbredsmæssige konsekvenser.Det undersøges om der er grund til at ændre holdning overfor antibiotika,hvilke faktorerderfremmer og hæmmer forsigtig antibiotikabrug og hvordan OASkunne optimeres.

METODE: Litteraturstudie efter struktureret litteratursøgning i PubMed og PsychINFO.

RESULTATER: Antibiotika betragtes som noget beskyttende. Det kan ikke udelukkes, at antibiotika ved at påvirke tarmfloraen, kan have negative konsekvenser for helbredet.Viden, vaner og kommunikation har betydning for hvordan antibiotika bruges og hvorvidt forsigtig antibiotikabrug opleves begribelig og håndterbar.Læger kan ved ordination af antibiotika opleve en konflikt mellem patienten,der skal behandles bedst muligtog samfundet, hvor tiltagende antibiotikaresistens skal begrænses. Dette kan være én grund til at forsigtig antibiotikabrug ikke opleves meningsfuld.

KONKLUSION: Forsigtig antibiotikabrug kunne fremmes ved atfremme velfungerende kommunikationog ved atbruge antibiotikas påvirkning af tarmfloraenog mulige helbredsmæssige konsekvenser som motivation. Hensigtsmæssige vaneri sammen-hæng med antibiotikabrug skal støttes og uhensigtsmæssige vaner om lægges. Her kunnelæger følges af en mikrobiolog for en dag

Abstract [en]

BACKGROUND:Drug resistance resulting from the overuse of antibiotics poses a threat to public health. Consequently, antibiotics must be used more cautiously.Intestinal flora is important to health and antibiotics can disrupt intestinal flora. Salutogenic theory is a well-established concept in public health. Sense of coherence (SOC), which is a key concept insalutogenic theory, reflects a person ́s lifeviewand capacity to respond to stressful situations, includes three components: comprehensibility, manageability and meaningfulness. SOC is a valuable tool for problems that target “compliant” behavior. Lack of SOC in both physicians and the general public may contribute to poor compliance to current guidelines that recommend restricting the use of antibiotics.

AIM: The study aimed to formulate proposals for promoting the prudent use of antibiotics by optimizing SOCbased on literature that illustrates(i) the attitudes of the general public and doctors regarding antibiotics and antibiotic resistance in Scandinavia and (ii) the influence and possible health consequences of antibiotics on intestinal flora. It is discussed whether there are reasons for looking at antibiotics in a different way, which factors that facilitate or hinder prudent antibiotic use and how SOC could be optimized.

METHODS: A literature study aftera structured search of the PubMed and Psych INFOdatabases.

RESULTS: Although antibiotics are generally considered protective, their effect on intestinal flora may have adverse health consequences. Knowledge, habits and communication affect how antibiotics are used and whether prudent antibiotic use is experienced comprehensible and manageable. Doctors may experience conflict when prescribing antibiotics between treating the patient in the best possible manner and the need to limit such treatment to protect the community from increased resistance to antibiotics. Doctors ́wish to guarantee that their patients receive the best possible treatment might be one reason why they do not adhere to guidelines that recommend more restrictive use of antibiotics. Doctors do not consider the cautious use of antibiotics as meaningful.

CONCLUSION: Careful antibiotic use could be promoted by using the influence of antibiotics on intestinal flora as motivational strategy;promoting effective communication and supporting appropriate and unlearn undesirable habits related to antibiotic use. A possible approach would be teaming physicians with a microbiologist for a day

Place, publisher, year, edition, pages
2014. , 53 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2014:43
Keyword [en]
antibiotics, gutflora, microbiota, sense of coherence, compliance
Keyword [da]
antibiotika, tarmflora, microbiota, oplevelse af sammenhæng, compliance
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3641OAI: oai:DiVA.org:norden-3641DiVA: diva2:783590
Presentation
2014-12-09, Nordic School of Public Health NHV, Göteborg, Sweden, 16:27 (Danish)
Supervisors
Note

ISBN 978-91-982282-8-1

Available from: 2015-01-26 Created: 2015-01-26 Last updated: 2015-01-26Bibliographically approved

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