Table 3

Description of the five identified categories

Category of descriptionDescriptionQuotation
A. Prefer “effective” treatmentIn this perception the basic notion was that the patient of today must be treated. However, infections, antibiotics and AR were of no interest in this perception. Therefore, to be sure that the patient would be cured, broad-spectrum antibiotics were selected. It was known that these antibiotics were not recommended, but in spite of this, they were chosen because they were perceived as effective. The threat of AR was perceived as a theoretical problem and was not kept in mind when antibiotics were prescribed.“The same antibiotics are used in treatment as in the prophylaxis, as I told you about. This is not so good, I know, but this is the way it is. Theory is theory but this is practice. That's why it is rather common that fluoroquinolones are also used in uncomplicated UTI. … Yes, I have seen resistant bacteria sometimes, with for example Lexinor. But this is nothing I have been thinking about.” (Interview 19)
B. Too uncertain to be restrictiveIn this category the main focus was also on the patient of today, but in addition there was a general notion that guidelines of restrictive treatment of infectious diseases should be followed. A restrictive treatment was, however, not practiced and the barrier for this was the physician's uncertainty. The uncertainty seemed to be a consequence of low interest in antibiotics and treatment of infectious diseases. It was expressed that narrow-spectrum antibiotics were considered but often regarded as not effective enough. Accordingly, to make the physician feel certain, extra doses of antibiotics were used as well as broader-spectrum antibiotics. Some physicians reflected on the consequences of their uncertainty, whereas others did not.“I think that we, because of uncertainty, may be somewhat more active. And for the same reason that we sometimes give more broad spectrum antibiotics than they do for example at the department of infectious diseases, it will be… When you do not know, you use something stronger.” (Interview 6)
C. Stuck in the healthcare systemThis perception has similarities with B but here the barrier for a restrictive treatment was the healthcare system. It was said that hospital care today means high tempo, many patients to take care of in a short time and a constant struggle to find free beds. Consequently, hospitalised patients must be effectively treated so they can be discharged as quickly as possible. The “wait and see” philosophy was not accepted any longer, and patients could not be brought back for follow-up visits. Accordingly, it was expressed that treatment today was often more potent than necessary.“Previously they were kept in the hospital to rest the intestine, today they are sent home with two antibiotics. … I think, that when we are not able to bring the patients back for a second visit, it makes us incautious and makes us use more [antibiotics] than we used before.” (Interview 5)
D. Aware and restrictive, but support requiredIn perception D the concept was, as in B and C, that the patient must be treated and guidelines for restrictive treatment should be followed. The difference was that here this was done in practice. As in perception B, infectious diseases were not of the highest interest. The strategy was to follow guidelines carefully, which here included the safe use of antibiotics with narrow spectrum in the treatment of most patients. Support from infectious disease specialists was considered necessary. Awareness of AR and the active prevention of AR had often been introduced by a colleague or an infectious disease specialist.“So in all treatment with antibiotics this [antibiotic resistance] is, so to speak, kept in one's mind. … To be frank, this is not exactly my main area of interest, and then you follow these recommendations and guidelines we get from the department of infectious diseases.” (Interview 4)
E. Aware, interested and competentIn this perception infectious diseases were a major interest and accordingly the treatment of patients was more diverse. It was often possible to use narrow-spectrum antibiotics and still guarantee the safety of the patient because the physician knew how to manage serious infections. In this conception the infectious disease specialists were important for updating of competence, but the treatment was most of the time managed without specialist counselling.“Yes, this [infectious diseases] is a major part of our work. … If you have an infection unit [at the hospital] it may look different than here, but for us infections are a very large part of our activities, I would say.” (Interview 17)
  • AR, antiobiotic resistance.

  • Each category is illustrated by a quotation