Sigurd Høye

• Lenander, Cecilia; Persson, Amelie; Hassani, Hajer Al; Hedin, Katarina; Høye, Sigurd & Jensen, Siri [Vis alle 9 forfattere av denne artikkelen] (2026). Import of antibiotics by air travellers – an observational study at airports in Sweden and Norway. Antimicrobial Resistance & Infection Control. 15. doi: 10.1186/s13756-026-01816-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Overuse and misuse of antibiotics are two of the main drivers of antimicrobial resistance (AMR). In some countries antibiotics can be purchased over the counter, whereas in Scandinavia and most of Europe, antibiotics require a prescription. It is permitted to bring medicines for personal use to Scandinavia. This raises concerns about whether antibiotics are being imported into low-prescribing countries, such as Scandinavia, via international airports. We aimed to investigate the quantity and types of antibiotics imported by air travellers entering Norway and Sweden, based on routine customs inspections at international airports. Methods A cross-sectional observational study was conducted during daytime over five weekdays at three international airports in Sweden and Norway. Anonymous data including the presence, type, and quantity of antibiotics, were registered alongside routine customs inspections. Defined daily doses (DDDs) were calculated for oral antibiotics. Substances were categorised according to the World Health Organization’s (WHO) AWaRe classification (Access, Watch and Reserve). Results Out of around 137,500 travellers arriving from abroad, 406 (0.30%) were inspected at routine customs inspections, of whom 57 (14%) carried antibiotics, corresponding to 643 DDDs. Inspected travellers from outside the EEA more often carried antibiotics than those within EEA ( p  < 0.001). More than one-third of the antibiotics were classified as ‘Watch’ according to the AWaRe classification. Conclusion We found that 14% of inspected international air travellers carried antibiotics. These antibiotics may be used without medical guidance, raising health risks and the risk of AMR. The findings highlight a potential need for public education and/or strengthened regulatory measures.

• Skow, Marius; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2026). Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway. Family Practice. ISSN 0263-2136. 43(2). doi: 10.1093/fampra/cmag001. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence. Objective T o assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics. Methods Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012–2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts). Results We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics. Conclusions Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

• Heltveit-Olsen, Silje Rebekka; Grude, Nils; Arnljots, Egill Snaebjörnsson; Sundvall, Pär-Daniel; Gunnarsson, Ronny & Kowalczyk, Anna [Vis alle 17 forfattere av denne artikkelen] (2026). Microbiological findings, antibiotic resistance rates and prescription practices for older women with recurrent urinary tract infections: a descriptive study alongside a multinational randomized controlled trial (ImpresU). JAC-Antimicrobial Resistance (JAC-AMR). 8(4). doi: 10.1093/jacamr/dlag121. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives To describe microbiological findings during asymptomatic and symptomatic phases in older women with recurrent urinary tract infections (rUTIs), to evaluate whether antimicrobial resistance patterns of Escherichia coli among methenamine hippurate users differ from untreated controls, and to explore prescription patterns of UTI antibiotics. Methods This was a descriptive study alongside a multinational randomized controlled trial (ImpresU). Women aged ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland and the Netherlands between December 2019 and June 2022. Participants were randomized to methenamine hippurate 1 g or placebo twice daily for 6 months, followed by a 6 month follow-up period. Urinary samples were collected at baseline (asymptomatic) and during acute UTIs. Results We included 281 women. A dominating uropathogen ≥105 cfu/mL was detected in 29% of the baseline urine samples. Of the 178 urinary cultures taken at acute UTIs, 163 (92%) had bacterial growth, of which a minority (10%) were reported as mixed flora. E. coli was most frequently detected both at baseline and in acute UTIs (present in any concentration in 32% versus 60% of urine samples), with highest resistance to amoxicillin (36% versus 43%), trimethoprim (16% versus 22%) and amoxicillin/clavulanate (12% versus 16%). ESBL-producing E. coli at baseline were rare (4.1%). Phylogenetic subgroup B2 was the most frequent E. coli phylotype at baseline (52%). No relevant differences in antimicrobial resistance rates were found between methenamine hippurate users and controls. Narrow-spectrum antibiotics were widely prescribed, and guideline adherence was high. Conclusions Physicians should be aware that 29% of older women with rUTIs in the community may have significant bacterial findings in their urine during asymptomatic phases.

• Eide, Torunn Bjerve; Norman, Rebecka Maria; Bjertnæs, Øyvind Andresen; Ørstavik, Jon & Høye, Sigurd (2025). Small group learning for specialists in general practice – structure, importance and potential. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(11). doi: 10.4045/tidsskr.25.0074. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Deltagelse i etterutdanningsgrupper (smågrupper) er en av flere obligatoriske aktiviteter for resertifisering av spesialiteten i allmennmedisin. Hensikten med studien var å øke kunnskap om gruppenes organisering, hvordan legene opplever deltagelsen og legenes holdninger til smågruppene som arena for kvalitetsforbedringstiltak. Materiale og metode Et digitalt spørreskjema med 28 åpne og lukkede spørsmål ble sendt til alle medlemmer i Norsk forening for allmennmedisin (N = 8 645) og alle smågruppesekretærer (N = 1 281) samt tilgjengeliggjort på Facebook-gruppen Allmennlegeinitiativet (> 5 000 medlemmer). Kvantitative resultater presenteres deskriptivt. Fritekstsvar ble analysert med tematisk analyse. Resultater De 555 respondentene hadde i gjennomsnitt vært med i smågruppen i 11,8 år (0–45 år). Blant disse svarte 508 personer (91,5 %) at de i stor eller svært stor grad var fornøyd med smågruppen. 306 (55,1 %) var helt enige i at det er lett å dele faglig usikkerhet i gruppen, og 489 (88,1 %) gledet seg alltid eller nesten alltid til møtene. Gruppens betydning for trygghet og støtte samt som en viktig arena for fellesskap var integrerte tema gjennom alle svarene i den kvalitative analysen. Mange beskrev gruppen som viktig for å orke å fortsette som allmennlege. Fortolkning Allmennlegenes smågrupper er en viktig arena for støtte og fellesskap og for å utveksle vanskelige erfaringer og faglig usikkerhet.

• Svaland, Malene; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund [Vis alle 7 forfattere av denne artikkelen] (2025). Fear of the Unknown: Pandemic Concerns Among Non-hospitalized COVID-19 Infected or Quarantined Norwegian Adults. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 19. doi: 10.1017/dmp.2025.10117. Fulltekst i vitenarkiv Vis sammendrag

  Objective We aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients. Methods We conducted a qualitative study of free text answers from participants of an online survey. The survey was conducted between March 2020 and June 2021. COVID-19 positive adults in home isolation and adults in quarantine were eligible for participation. 698 participants answered one or more of three open-ended questions about concerns and safety. We analyzed free-text answers using thematic analysis according to Braun and Clarke with an inductive approach. Results Analysis of the free-text answers from all participants identified three main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis. Participants’ feelings revolved around health-related concerns and societal related concerns. They were concerned about their own and other’s health, and possible long-term consequences of COVID-19 infection. Some participants were satisfied with the health care system, others thought follow-ups, testing, vaccination, and information would increase their feeling of safety. Conclusions People quarantined and isolated due to the COVID-19 pandemic had concerns regarding personal health and societal consequences of infection control measures. Health care follow-ups and individualized information would increase participants’ feeling of safety.

• Christiansen, Cathrine S; Høye, Sigurd; Lindbæk, Morten; Halvorsen, Jon Anders & Emilsson, Louise (2025). Acne management in Norway: GP and dermatologist prescriptions (2012–2019): a nationwide overview. British Journal of General Practice Open. 9(3). doi: 10.3399/bjgpo.2024.0211. Fulltekst i vitenarkiv Vis sammendrag

  Background Acne is common and associated with negative psychosocial health and risk of permanent skin alterations. GPs prescribe the main portion of antibiotics used for acne. Increased isotretinoin prescription by GPs can potentially reduce overall antibiotic use, but prescription practice and trends are unknown. Aim To examine acne treatment in Norway and quantify prescription and initiation of isotretinoin and tetracyclines. Design & setting An observational study linking data from health registries. Data were collected from the Norwegian Prescription Database (NorPD), the national GP claims register (KUHR database), and the Regular General Practitioner (RGP) registry. Method All patients aged 12–39 years who received an acne diagnosis or were prescribed acne medication in Norway 2012–2019 were included. Linear regression was used to explore time trends. Results In total, 316 075 patients were included (63% female). Yearly prevalence of systemic treatment increased from 1.9 in 2012 to 2.4% in 2019; isotretinoin increased by +123%, tetracyclines by +4% as measured in defined daily doses (DDDs). Topical treatment increased by +13% as measured by number of prescriptions. GP prescription of tetracyclines decreased 11%; however, courses had a mean duration of 160 days, which is longer than the recommended 90 days, and only 26% had a co-occurring topical treatment prescription. GPs initiated 5% of isotretinoin courses in 2012, versus 10% in 2019, and 19% ( n = 1339) of GPs initiated isotretinoin at least once during the study period. Conclusion GPs reduced their prescription of tetracyclines, but our data still show potential for further improvements in prescribing practice. Increased isotretinoin prescription by GPs may lead to reduced antibiotic use and better treatment regimens for moderate-to-severe acne.

• Xu, Alice X. T; Brown, Kevin; Schwartz, Kevin L; Aghlmandi, Soheila; Alderson, Sarah & Brehaut, Jamie C [Vis alle 36 forfattere av denne artikkelen] (2025). Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis. Clinical Infectious Diseases. ISSN 1058-4838. 80(2), s. 253–262. doi: 10.1093/cid/ciae604. Fulltekst i vitenarkiv Vis sammendrag

  Background This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness. Methods Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov were searched up to May 2024. Trial, participant, and intervention characteristics were extracted independently by 2 researchers. Random effects meta-analyses of trials that compared interventions with and without A&F were conducted for 4 outcomes: (1) total antibiotic prescribing volume; (2) unnecessary antibiotic initiation; (3) excessive prescription duration, and (4) broad-spectrum antibiotic selection. A stratified analysis was also performed based on study characteristics and A&F intervention design features for total antibiotic volume. Results A total of 56 RCTs fit the eligibility criteria and were included in the meta-analysis. A&F was associated with an 11% relative reduction in antibiotic prescribing volume (N = 21 studies, rate ratio [RR] = 0.89; 95% confidence interval [CI]: .84, .95; I2 = 97); 23% relative reduction in unnecessary antibiotic initiation (N = 16 studies, RR = 0.77; 95% CI: .68, .87; I2 = 72); 13% relative reduction in prolonged duration of antibiotic course (N = 4 studies, RR = 0.87 95% CI: .81, .94; I2 = 86); and 17% relative reduction in broad-spectrum antibiotic selection (N = 17 studies, RR = 0.83 95% CI: .75, .93; I2 = 96). Conclusions A&F interventions reduce antibiotic prescribing in primary care. However, heterogeneity was substantial, outcome definitions were not standardized across the trials, and intervention fidelity was not consistently assessed.

• Heltveit-Olsen, Silje Rebekka; Arnljots, Egill Snaebjörnsson; Sundvall, Pär-Daniel; Gunnarsson, Ronny; Kowalczyk, Anna & Godycki-Cwirko, Maciej [Vis alle 16 forfattere av denne artikkelen] (2025). Methenamine hippurate as prophylaxis for recurrent urinary tract infections in older women - a triple-blind, randomised, placebo-controlled, phase IV trial (ImpresU). Clinical Microbiology and Infection (CMI). ISSN 1198-743X. 31(11), s. 1873–1879. doi: 10.1016/j.cmi.2025.07.006. Fulltekst i vitenarkiv Vis sammendrag

  Objectives This study aims to investigate the preventive effect of the antiseptic methenamine hippurate on recurrent urinary tract infections (rUTIs) in older women. Methods Triple-blind, randomised, placebo-controlled phase IV trial with a 6-month treatment period and a 6-month follow-up. Women ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland, and The Netherlands. Recruitment started in December 2019, with follow-up completed at the end of June 2023. Participants were randomly assigned to methenamine hippurate 1g × 2 or placebo 1 tablet × 2 for 6 months. The primary outcome was the number of antibiotic treatments for urinary tract infections (UTIs) during the treatment period. Secondary outcomes included the number of antibiotic treatments for UTIs during the follow-up period, UTI symptom severity and episode duration. Differences in complications were measured as safety outcomes. Results Of 289 recruited women, 281 (97%) were included in the main analysis (140 in the methenamine hippurate group, 141 in the placebo group). During the treatment period, the methenamine hippurate group had a lower incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 0.75 (95% CI: 0.57–1.0, p 0.049). In the follow-up period, the ratio was reversed: the methenamine hippurate group had a higher incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 1.7 (95% CI:1.3–2.3, p<0.001). There were no important differences in UTI symptom severity/duration or complications between the groups. Discussion Methenamine hippurate reduces the frequency of rUTIs in older women with a point estimate of a 25% reduction, suggesting advantages over low-dose antibiotic prophylaxis because of its low potential for selection for antimicrobial resistance and mild side effects. However, discontinuation after 6-month treatment duration seems to increase the risk of UTI relapses, and physicians should be aware of this risk when initiating or discontinuing treatment.

• Thaulow, Jorunn; Eide, Torunn Bjerve; Høye, Sigurd & Skjeie, Holgeir (2025). Patients’ perspectives regarding antibiotic treatment for acute sinusitis in Norwegian general practice. A qualitative interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(3), s. 693–701. doi: 10.1080/02813432.2025.2498510. Fulltekst i vitenarkiv Vis sammendrag

  Background The prescription rate for antibiotics for acute sinusitis in primary care remains high, despite evidence showing their limited effectiveness. GPs frequently encounter patient demands for antibiotics, which can influence their decision-making process. Aim This study aimed to explore the help-seeking and expectations of patients experiencing symptoms of acute sinusitis, with a particular focus on their desire for antibiotics. We sought to understand why patients seek their GP for sinusitis, what kind of treatment they hope to receive, and how they perceive their influence on the GP’s treatment decision. Methods We conducted 12 semi-structured interviews with patients who had consulted their GP for acute sinusitis from various regions across Norway. The qualitative analysis was performed using systematic text condensation. Results We developed 3 main themes:1. ‘Pain and exhaustion’- Patients primarily consulted their GP for acute sinusitis seeking medication to alleviate pain and accelerate recovery.2. ‘I trust the GP, but mainly myself’- While patients expressed trust in their GPs, they also had clear expectations of receiving the specific treatment they sought. 3. ‘Antibiotics works’- Most patients associated medication with antibiotics and believed they were effective against sinusitis. Conclusion Patients with sinusitis primarily visited their GP to seek relief from pain and to obtain medication that they believe could speed up recovery, which often meant antibiotics. These findings suggest a continuing need for measures targeting both doctors and patients to align treatment expectations, improve adherence to clinical guidelines, and adjust patient expectations. Better pain management of sinusitis should be emphasized.

• Sætre, Håkon; Skow, Marius Andre Hybbestad; Vik, Ingvild; Høye, Sigurd & Emilsson, Louise (2024). Acute cystitis in men– a nationwide study from primary care: antibiotic prescriptions, risk factors, and complications. British Journal of General Practice Open. 8(2). doi: 10.3399/BJGPO.2023.0207. Fulltekst i vitenarkiv Vis sammendrag

  Background Research on acute cystitis in men is scarce and treatment guidelines differ between countries. Improved antibiotic stewardship is needed. Aim To analyse antibiotic prescriptions and outcomes of Norwegian men diagnosed with cystitis in primary care. Design & setting A nationwide retrospective study was undertaken in primary care in Norway. Method We identified all episodes of acute cystitis in men diagnosed in Norwegian primary care during 2012–2019. Choice of antibiotic (from the Norwegian Prescription Database), treatment failure, re-prescription, and complications were stratified by age, calendar year, and risk factors. We used logistic regression to explore predefined risk factors (diabetes, prostate cancer, benign prostate hyperplasia [BPH], urinary retention, and any cancer) with complications (pyelonephritis, prostatitis, and hospitalisation) and re-prescriptions. Linear regression was used to explore time trends. Results In total, 108 994 individuals contributed 148 635 episodes. Narrow-spectrum antibiotics were first-choice treatment in 71.0% of the episodes (52.5% of all prescriptions were pivmecillinam). More than 75% of the episodes with narrow-spectrum versus 82.2% of broad-spectrum treatment did not lead to any re-prescription or complication. Complications occurred in 1.8% of all episodes (0.5% prostatitis, 0.7% pyelonephritis, and 0.7% hospitalisation). BPH was associated with increased risk of complications and re-prescription. Diabetes was associated with a lower risk of re-prescriptions. Prostate cancer and urinary retention were associated with a lower risk of both complications and re-prescriptions. Conclusion Our results support narrow-spectrum antibiotics as first-line treatment. Risk factor analyses warrants further investigation.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2024). Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1), s. 214–224. doi: 10.1080/02813432.2023.2301562. Fulltekst i vitenarkiv Vis sammendrag

  Objective - To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.<p> <p>Design - Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.<p> <p>Results - Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.<p> <p>Conclusions - The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

• Eide, Torunn Bjerve; Skjeie, Holgeir & Høye, Sigurd (2024). Quality improvement work in general practice; a Norwegian focus group study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2024.2380920. Fulltekst i vitenarkiv Vis sammendrag

  Background Quality improvement work is an essential feature of healthcare services, including general practice. In this study, we aimed to gain more knowledge regarding general practitioners’ (GPs) motivation for such work in their practices, as well as what kind of measures were considered motivating and feasible. Materials and methods We conducted five focus group interviews among Norwegian GPs between November 2021 and November 2022. We included 21 GPs of varying age, gender, experience, and geographic situation. The data were transcribed verbatim and analysed by Systematic Text Condensation, a thematic cross-case analysis. Results Many GPs had a diverse and imprecise understanding of the term quality improvement, and sound routines in everyday practice were often given as examples of quality improvement measures. There was a universal attitude that quality improvement initiatives should be close to practice, professionally relevant, and sufficiently small to be manageable. The availability of professional communities, either in the GP practices or in continuous medical education groups, was important for motivation. The role of nurses and health secretaries was highlighted as essential to achieve change. Participants commonly described negative reactions to programs that were imposed by external actors without regard for the GPs’ perceived needs. Conclusion GPs were motivated for quality improvement measures provided feasibility within the framework of general practice. Well-functioning professional communities, including involvement of nurses and health-secretaries, were emphasised as requisite for quality improvement. Small scale quality improvement programs suited for the needs of general practice were well received and should be further developed.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Lithén, Sara Sofia [Vis alle 17 forfattere av denne artikkelen] (2024). Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial. Trials. 25(1). doi: 10.1186/s13063-024-08545-4. Fulltekst i vitenarkiv Vis sammendrag

  Background We previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice. Methods We conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework. Results The questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers. Conclusions We found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation. Trial registration ClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

• Heltveit-Olsen, Silje Rebekka; Gopinathan, Unni; Blix, Hege Salvesen; Elstrøm, Petter & Høye, Sigurd (2024). Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway - an interrupted time series analysis. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 79(5), s. 1109–1117. doi: 10.1093/jac/dkae078. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. Objective To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Methods Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. Results We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P &amp;lt; 0.001), followed by a significant reduction of −2.64 prescriptions after reintroduction (95%CI −3.66, −1.63, P &amp;lt; 0.001). Conclusions During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

• Hansen, Malene Plejdrup; Høye, Sigurd & Hedin, Katarina (2024). Antibiotic treatment recommendations for acute respiratory tract infections in Scandinavian general practices—time for harmonization? Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1), s. 205–208. doi: 10.1080/02813432.2024.2422441. Fulltekst i vitenarkiv Vis sammendrag

  Introduction During recent years, the world—including Scandinavia—has experienced significant challenges with shortages of antibiotics. In Scandinavia, phenoxymethylpenicillin is recommended as first-line antibiotic treatment for most acute respiratory tract infections (ARTIs). However, the Scandinavian countries each constitute rather small markets for phenoxymethylpenicillin. The aim of this discussion paper is to enlighten the differences in Scandinavian ARTI antibiotic treatment recommendations. This information is fundamental for exploring the potential of harmonizing treatment recommendations in Denmark, Norway and Sweden—to help ensure sufficient future supply of phenoxymethylpenicillin. Methods Information from national ARTI antibiotic treatment recommendations from respectively Denmark, Norway and Sweden has been collated. Results Several discrepancies exist in recommendations. Adult dosage varies from a minimum of 660 mg x 4 (Denmark) to a maximum of 2000 mg × 3 (Sweden). Within Norway and Sweden, variations in recommended dosage also exist between the different types of ARTIs. A main challenge is that the tablet strengths recommended, and available on the market in the three countries, differs. Also, antibiotic treatment durations vary significantly between countries and infections treated—from five to 10 days of treatment. Conclusion In the capacity of a well-established network for antibiotic stewardship, we have enlightened the differences in Scandinavian ARTI antibiotic treatment recommendations. This paper is the first step moving forward to scrutinizing the potential for harmonizing recommendations for Denmark, Norway and Sweden—to help ensure continued supply of phenoxymethylpenicillin for use within the Scandinavian countries.

• Thaulow, Jorunn; Eide, Torunn Bjerve; Høye, Sigurd & Skjeie, Holgeir (2023). Decisions regarding antibiotic prescribing for acute sinusitis in Norwegian general practice. A qualitative focus group study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2023.2274328. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute sinusitis is a frequent reason for primary care visits. Most patients recover within two weeks without antibiotic treatment. Despite this, about 50% of patients with acute sinusitis in Norwegian general practice are still prescribed antibiotics. We do not know the reason behind this discrepancy. Aim To explore the clinical decision-making process and reasons for treatment with antibiotics for acute sinusitis among Norwegian general practitioners (GPs). Methods Five focus group interviews were conducted (N = 25) in different parts of Norway, including GPs of various age, gender, and experience. The interviews were analysed using Systematic Text Condensation. Results The results showed a very diverse management of acute sinusitis among GPs, with decisions regarding antibiotics not always aligning with guideline recommendations. Many of the GPs did not agree with the Norwegian guidelines for antibiotics and chose something other than phenoxymethylpenicillin as their first choice. Clinical predictors emphasized in decision-making were pain complaints and patient exhaustion. Pragmatic factors such as weekday, travel plans, or a full waiting room could also influence the decision. Conclusion GPs found it difficult to identify when patients would benefit from antibiotic treatment for acute sinusitis, and different strategies were used to make prescribing decisions. For several GPs the degree of pain was one of the decisive reasons for antibiotic prescribing, however the guidelines for antibiotics do not give sufficient advice regarding pain treatment. These results suggest a need for revaluation of guideline contents and the way they are communicated to GPs. Key Points We know that antibiotics are often overused in the treatment of acute sinusitis, but there is lack of knowledge about the reasons behind GPs decision to prescribe them. There were considerable variations in clinical decision-making regarding the treatment of acute sinusitis among Norwegian GPs. The patients’ pain level, as well as pragmatic factors, were important deciding factors in the prescription of antibiotics. Guidelines for treatment regarding acute sinusitis may include more emphasis on pain management.

• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2023). Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC-Antimicrobial Resistance (JAC-AMR). 5(1). doi: 10.1093/jacamr/dlac135. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012–2019. Methods Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. Results RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). Conclusions This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012–2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

• Hartman, Esther; Pol, Alma C. Van De; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Lithén, Sara Sofia [Vis alle 18 forfattere av denne artikkelen] (2023). Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries. The BMJ. doi: 10.1136/bmj-2022-072319. Fulltekst i vitenarkiv Vis sammendrag

  Objective To evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention. Design Pragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period. Setting 38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021. Participants 1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period. Intervention Healthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual. Main outcome measures The primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality. Results The numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v 0.05 per person year), hospital referrals (<0.01 v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26). Conclusions Implementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults.

• Mølsæter, Anne Britt; Henni, Silje Havrevold; Opheim, Randi; Høye, Sigurd & Børøsund, Elin (2023). Antibiotikasmarte sykepleierstudenter? Sykepleierstudenters kunnskap og egenvurdert kompetanse om antibiotikabruk og -resistens. Sykepleien Forskning. ISSN 1890-2936. 18(93743), s. 1–13. doi: 10.4220/Sykepleienf.2023.93743. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Moderne medisin er avhengig av virksom antibiotika. Imidlertid har antibiotikaresistens blitt et raskt voksende problem i verden, som utgjør en alvorlig trussel mot den globale helsen. Riktig antibiotikabruk er avgjørende for å redusere antibiotikaresistensen i fremtiden. Norske sykepleierstudenters kunnskapsnivå om antibiotikabruk og -resistens er lite utforsket. Hensikt: Å kartlegge sykepleierstudenters kunnskap om antibiotikaresistens og antibiotikabruk. Vi ønsket også å undersøke hvordan de vurderer sin egen kompetanse på dette området. Metode: Studien har et deskriptivt tverrsnittsdesign. Dataene ble samlet inn via et spørreskjema utdelt til sykepleierstudenter ved fire utvalgte utdanningsinstitusjoner fra september 2019 til februar 2020. Kartleggingen besto av et spørreskjema med 43 spørsmål, fordelt på ni spørsmål om egenvurdering av kunnskap og 34 kunnskapsspørsmål om antibiotikabruk inndelt i seks temaer. Vi anvendte ANOVA, t-tester og bivariate korrelasjonsanalyser for å vurdere sammenhengen mellom faktisk kunnskap om antibiotikabruk og egenvurdering av kunnskap, tidligere arbeidserfaring i helsevesenet, frivillig eller obligatorisk undervisning, undervisningssted og alder. Resultat: Av 480 forespurte studenter deltok 410 (84,5 prosent) i studien. Studentene hadde en gjennomsnittskår på 48,6 prosent korrekte svar for alle kunnskapsspørsmålene samlet. De hadde minst kunnskap om temaene om antibiotikaforbruk, urinveisinfeksjon og asymptomatisk bakteriuri samt allergi og bivirkninger. En høy andel av studentene vurderte sin egen kunnskap om antibiotikaresistens og riktig antibiotikabruk som lav. Jo høyere studentene skåret på kunnskapsnivå, jo høyere vurderte de sin egen kunnskap. Verken alder, tidligere jobberfaring, eller hvorvidt undervisningen var frivillig eller obligatorisk, hadde sammenheng med kunnskapsnivået. Konklusjon: Sykepleierstudenter har mangelfull kunnskap om antibiotikaresistens og riktig antibiotikabruk, og de vurderer også selv at de har lite kunnskap og lav kompetanse. Resultatene indikerer et behov for å styrke studentenes kompetanse, slik at de kan benytte sin profesjon bedre til å påvirke og forebygge antibiotikaresistens. Videre forskning bør undersøke om kunnskapsnivået er forbedret etter at flere av studiestedene har satt i gang undervisning etter at studien ble utført.

• Høye, Sigurd (2023). Kostnad og nytte ved penicillinmikstur til barn. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(12). doi: 10.4045/tidsskr.23.0534. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2023). Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study. BMC Health Services Research. 23. doi: 10.1186/s12913-022-08994-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Telephone triage has been established in many countries as a response to the challenge of non-urgent use of out-of-hours primary care services. However, limited evidence is available regarding the effect of training interventions on clinicians’ telephone consultation skills and patient outcomes. Methods This was a pragmatic randomized controlled educational intervention for telephone triage nurses in 59 Norwegian out-of-hours general practitioners’ (GPs) cooperatives, serving 59% of the Norwegian population. Computer-generated randomization was performed at the level of out-of-hours GP cooperatives, stratified by the population size. Thirty-two out-of-hours GP cooperatives were randomized to intervention. One cooperative did not accept the invitation to participate in the educational programme, leaving 31 cooperatives in the intervention group. The intervention comprised a 90-minute e-learning course and 90-minute group discussion about respiratory tract infections (RTIs), telephone communication skills and local practices. We aimed to assess the effect of the intervention on out-of-hours attendance and describe the distribution of RTIs between out-of-hours GP cooperatives and list-holding GPs. The outcome was the difference in the number of doctor’s consultations per 1000 inhabitants between the intervention and control groups during the winter months before and after the intervention. A negative binomial regression model was used for the statistical analyses. The model was adjusted for the number of nurses who had participated in the e-learning course, the population size and patients’ age groups, with the out-of-hours GP cooperatives defined as clusters. Results The regression showed that the intervention did not change the number of consultations for RTIs between the two groups of out-of-hours GP cooperatives (incidence rate ratio 0.99, 95% confidence interval 0.91–1.07). The winter season’s out-of-hours patient population was younger and had a higher proportion of RTIs than the patient population in the list-holding GP offices. Laryngitis, sore throat, and pneumonia were the most common diagnoses during the out-of-hours primary care service. Conclusions The intervention did not influence the out-of-hours attendance. This finding may be due to the intervention’s limited scope and the intention-to-treat design. Changing a population’s out-of-hours attendance is complicated and needs to be targeted at several organizational levels.

• Rydland, Eva; Høye, Sigurd & Størdal, Ketil (2023). Antibiotic use for airway infections in Norwegian children—A national register-based study. Acta Paediatrica. ISSN 0803-5253. 113(3), s. 537–543. doi: 10.1111/apa.17052. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aim Respiratory tract infections (RTIs) are major contributors to childhood antibiotic use. We aimed to investigate geographical and temporal trends in the prescription of antibiotics and consultations for RTIs in children &lt;18 years living in Norway from 2010 to 2017. Methods In a nationwide observational study, we analysed antibiotic prescriptions from the Norwegian Prescription Database and reimbursed contacts from primary care physicians. We limited the study to airway antibiotics and diagnostic codes indicating RTIs. Results Antibiotic prescriptions due to an RTI varied from 75 to 134 per 1000 consultation due to RTI across counties in Norway (relative risk 1.79, 95% CI 1.68–1.90 for highest compared to lowest). The use of health care varied from 414 to 585 consultations for RTI per 1000 inhabitant/year (relative risk 1.43, 95% CI 1.41–1.44 for highest compared to lowest). From 2010 to 2017, we observed a 21% reduction in antibiotic prescriptions per RTI consultation and of 6% for the number of consultations for an RTI. At the county level, the use of health care was positively associated with the proportion of RTIs that resulted in antibiotic prescription. Conclusion We found a reduction in doctors' antibiotic prescription and the use of health care for RTIs, and a variation across counties.

• Schwartz, Kevin L.; Xu, Alice X. T.; Alderson, Sarah; Bjerrum, Lars; Brehaut, Jamie & Brown, Benjamin C. [Vis alle 24 forfattere av denne artikkelen] (2023). Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN). Antimicrobial Resistance & Infection Control. 12(1). doi: 10.1186/s13756-023-01279-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. Objective To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance—Primary Care Antibiotic Audit and Feedback Network. Methods We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. Results The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). Conclusion We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

• Michalsen, Benedikte Olsen; Xu, Alice X. T; Alderson, Sarah L.; Bjerrum, Lars; Brehaut, Jamie & Bucher, Heiner C. [Vis alle 22 forfattere av denne artikkelen] (2023). Regional and national antimicrobial stewardship activities: a survey from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN). JAC-Antimicrobial Resistance (JAC-AMR). 5(2). doi: 10.1093/jacamr/dlad048. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund (2023). Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), s. 427–434. doi: 10.1080/02813432.2023.2266477. Fulltekst i vitenarkiv Vis sammendrag

  Objective Dependent on clinical setting, geography and timing during the pandemic, variable symptoms of COVID-19 have been reported. Our aim was to describe self-reported symptom intensity and contact with primary health care among nonhospitalized COVID-19 patients. Design Web-based survey. Setting Norway between March 2020 and July 2021. Subjects Adults in home isolation. Main outcome measures Participants reported possible COVID-19 symptoms, duration of symptoms, score of symptom severity (Likert scale 0–3), risk factors, comorbidity, and questions regarding follow-up and information from primary health care. Results Of 477 participants, 379 (79%) had PCR-confirmed COVID-19, 324 (68%) were females, and 90% were younger than 60 years. Most common symptoms were “fatigue and/or muscle ache” (80%), nasal symptoms (79%), and headache (73%). The mean severity of symptoms was generally low. Symptoms with the highest mean scores were “fatigue and/or muscle ache” (1.51, SD 1.02) and headache (1.27 (SD 1.00). Mean scores for severity ranged from 0.28 (nausea) to 1.51 (fatigue and/or muscle ache). Women reported higher symptom scores than men. For “affected sense of smell and/or taste”, patients either reported a high symptom score (24%) or no affliction at all (49%). A third of the participants (32%) were followed-up by primary care health personnel, and almost 40% had sought or received information about COVID-19 from general practitioners. Conclusion The mean severity of symptoms among nonhospitalized adult COVID-19 patients was generally low. We found large variations in the occurrence and severity of symptoms between patients.

• Skow, Marius Andre Hybbestad; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 78(9), s. 2217–2227. doi: 10.1093/jac/dkad227. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate. Methods All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes. Results A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5–2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes. Conclusions Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.

• Puntervoll, Hanne Eknes; Jenum, Pål; Høye, Sigurd & Tollånes, Mette Christophersen (2022). Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 40(4), s. 466–473. doi: 10.1080/02813432.2022.2144982. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria Lyche; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2142796. Fulltekst i vitenarkiv Vis sammendrag

  Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.<p> <p>Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. <p>Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. <p>Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.

• Heltveit-Olsen, Silje Rebekka; Sundvall, Pär-Daniel; Gunnarsson, Ronny; Arnljots, Egill Snaebjörnsson; Kowalzcyk, Anna & Godycki-Cwirko, Maciek [Vis alle 15 forfattere av denne artikkelen] (2022). Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU). BMJ Open. 12:e065217(11), s. 1–11. doi: 10.1136/bmjopen-2022-065217. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Methenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs. Methods and analysis The ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups of Escherichia coli present in the urine culture at inclusion have a modifying effect on the outcomes. Ethics and dissemination Ethical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 16 forfattere av denne artikkelen] (2022). Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: A qualitative study in four European countries. Age and Ageing. ISSN 0002-0729. 51(6). doi: 10.1093/ageing/afac134. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions.

• Eide, Torunn Bjerve; Øyane, Nicolas Melchior Frederic & Høye, Sigurd (2022). Promoters and inhibitors for quality improvement work in general practice: a qualitative analysis of 2715 free-text replies. BMJ Open Quality. 11:e001880(4), s. 1–8. doi: 10.1136/bmjoq-2022-001880. Fulltekst i vitenarkiv Vis sammendrag

  Background Continuous quality improvement (QI) is necessary to develop and maintain high quality general practice services. General Practitioners (GPs’) motivation is an important factor in the success of QI initiatives. We aimed to identify factors that impair or promote GPs’ motivation for and participation in QI projects. Material and methods We analysed 2715 free-text survey replies from 2208 GPs participating in the QI intervention ‘Correct Antibiotic Use in the Municipalities’. GPs received reports detailing their individual antibiotic prescriptions for a defined period, including a comparison with a corresponding previous period. The content was discussed in peer group meetings. Each GP individually answered work-sheets on three separate time-points, including free-text questions regarding their experiences with the intervention. Data were analysed using inductive thematic analysis. Results We identified three overarching themes in the GPs’ thoughts on inhibitors and promoters of QI work: (1) the desire to be a better doctor, (2) structural and organisational factors as both promoters and inhibitors and (3) properties related to different QI measures. The provision of individual prescription data was generally very well received. The participants stressed the importance of a safe peer group, like the Continuous Medical Education group, for discussions, and also underlined the motivating effect of working together with their practice as a whole. Lack of time was essential in GPs’ motivation for QI work. QI tools should be easily available and directly relevant in clinical work. Conclusion The desire to be good doctor is a strong motivator for improvement, but the framework for general practice must allow for QI initiatives. QI tools must be easily obtainable and relevant for practice. Better tools for obtaining clinical data for individual GPs are needed.

• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2021). Phone triage nurses’ assessment of respiratory tract infections–the tightrope walk between gatekeeping and service providing. A qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(2), s. 139–147. doi: 10.1080/02813432.2021.1908715. Fulltekst i vitenarkiv Vis sammendrag

  Aim To measure change in service user involvement in secure mental health units, before and after the implementation of recovery-oriented practice. Design Quasi-experimental study pretest–posttest design with non-equivalent comparison groups. Methods Data were collected from May 2018 to December 2019 in four medium-/high-security units in Norway. Two intervention units that implemented recovery-oriented practice were compared with two comparison units that did not. Data were obtained using anonymous questionnaires at baseline and at 6-month follow-up. For intervention units, data were also obtained at a 12-month follow-up to measure sustainability of improvements over time. Twenty inpatients (‘patients’; intervention group: 10, comparison group: 10) and 141 members of frontline staff (‘service providers’; intervention group: 92, comparison group: 49) participated at baseline. Mann–Whitney U-tests and independent sample t-tests were applied at the group-level to analyse changes in mean scores in groups. Results Among patients in the intervention units, findings indicated no improvements after 6 months, but significant improvements after 12 months in terms of patients’ opportunities to participate in formulating their individual care plans, to influence decision-making about therapy and to receive information about complaint procedures. Opportunities to participate in discussions about medication and treatment regimens did not improve. After 6 months, service providers in the intervention units reported an increase in democratic patient involvement, patient collaboration and management support, but not in carer involvement and assisted patient involvement. The improvements in democratic patient involvement and management support were sustained over time. No changes were found in the comparison groups. Conclusion The patients and the service providers reported a higher degree of service user involvement after implementing recovery-oriented practice. Specific work is needed to ensure patients’ involvement in all domains.

• Høye, Sigurd & Lindbæk, Morten (2021). Riktigere bruk av antibiotika i primærhelsetjenesten. Michael quarterly. Supplement. ISSN 1893-0808. 18(28), s. 134–140. Fulltekst i vitenarkiv Vis sammendrag

  Antibiotika er en begrenset ressurs, og fornuftig bruk av antibiotika i primærhelsetjenesten er nødvendig for å redusere utbredelsen av antibiotikaresistens. Infeksjonstilstander og antibiotikabruk i primærhelsetjenesten er blant de viktigste forskningsområdene ved Avdeling for allmennmedisin. Forskningen er knyttet til Antibiotikasenteret for primærmedisin, et nasjonalt kompetansesenter som skal fremme rasjonell og begrenset bruk av antibiotika i primærhelsetjenesten. Resultatene fra forskningen har fått direkte innvirkning på pasientbehandlingen i primærhelsetjenesten.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Sundvall, Pär-Daniel [Vis alle 17 forfattere av denne artikkelen] (2021). Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial. BMJ Open. 11(10), s. 1–8. doi: 10.1136/bmjopen-2021-052552. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Almost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting. Methods and analysis First, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021. Ethics and dissemination Ethical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations.

• Blix, Hege Salvesen & Høye, Sigurd (2021). Bruk av antibiotika under covid-19-pandemien. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(4), s. 353–356. doi: 10.4045/tidsskr.20.1003. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Det har vært interesse knyttet til bruken av antibiotika under covid-19-pandemien. I denne artikkelen presenterer vi forbruket av systemisk antibiotika i Norge i pandemiperioden. MATERIALE OG METODE Totalt salg av systemisk antibiotika i definerte døgndoser (DDD) ble innhentet fra Grossistbasert legemiddelregister for 2019 og 2020, og salg av antibiotika til bruk utenfor institusjon ble innhentet fra Reseptregisteret. Informasjon om andel brukere (prevalens), doser (målt i DDD) og resepter ble innhentet. RESULTATER Totalt salg av systemiske antibiotika økte i mars 2020, men salg til personer utenfor institusjon økte ikke. Sammenliknet med tidligere år sank både totalforbruket og bruk av antibiotika utenfor institusjon kraftig de påfølgende månedene. Reduksjonen var størst for antibiotika mot luftveisinfeksjoner og i de yngste aldersgruppene. FORTOLKNING Den sterke reduksjonen i bruk av systemiske antibiotika under covid-19-pandemien tilskrives smitteverntiltak og redusert kontakt med helsetjenesten. Regjeringen satte i 2016 et mål om 30 % redusert antibiotikabruk innen utgangen av 2020. Pandemien har bidratt til at målet er nådd.

• Eig, Ruth Davey; Harbin, Nicolay Jonassen; Gjelstad, Svein; Høye, Sigurd; Jensen, Siri & Lindbæk, Morten [Vis alle 7 forfattere av denne artikkelen] (2020). RASK – Promoting appropriate use of antibiotics in municipal healthcare institutions. I Simonsen, Gunnar Skov; Blix, Hege Salvesen; Grave, Kari & Urdahl, Anne Margrete (Red.), NORM/NORM-vet 2019. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. NORM/NORM-VET. s. 42–43. Fulltekst i vitenarkiv
• Høye, Sigurd; Lindbæk, Morten & Blix, Hege Salvesen (2020). RAK – Promoting appropriate use of antibiotics among general practitioners. I Simonsen, Gunnar Skov; Blix, Hege Salvesen; Grave, Kari & Urdahl, Anne Margrete (Red.), NORM/NORM-vet 2019. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. NORM/NORM-VET. s. 40–41. Fulltekst i vitenarkiv
• Harbin, Nicolay Jonassen; Eig, Ruth Davey; Høye, Sigurd; Gjelstad, Svein; Jensen, Siri & Lindbæk, Morten [Vis alle 7 forfattere av denne artikkelen] (2020). Antibiotic use in nursing homes. I Simonsen, Gunnar Skov; Blix, Hege Salvesen; Grave, Kari & Urdahl, Anne Margrete (Red.), NORM/NORM-vet 2019. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. NORM/NORM-VET. s. 42–42. Fulltekst i vitenarkiv
• Høye, Sigurd; Brænd, Anja Maria & Spehar, Ivan (2020). Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 38(3), s. 352–359. doi: 10.1080/02813432.2020.1794400. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study aimed to explore the conditions for the Municipal Chief Medical Officers’ (MCMOs) involvement in quality improvement in general practice, specifically concerning antibiotic prescribing practices. Methods This qualitative study consisted of semi-structured in-depth telephone interviews and group interviews with MCMOs (n = 12). The interview guide aimed to explore the MCMOs’ views on their role and responsibilities regarding the quality of care in general practice. The data were analysed using systematic text condensation. Results Three main themes were identified: 1) the relationship between the municipality and the general practitioner (GP), with the MCMO acting as an intermediary, 2) influencing the GPs’ work and 3) antibiotic use and infection control. The MCMOs perceived themselves as liaisons between the municipalities and the GPs. They emphasized building trust, showing respect and sharing common values in their interactions with the GPs, upholding the GPs’ professional autonomy. Working for quality improvement was considered a priority; however, MCMOs expressed a need for external support to establish a permanent quality improvement framework. The informants were positive about engaging in improving antibiotic prescribing practices because this combined the municipality’s responsibilities for quality improvement and communicable disease control. Conclusions The MCMOs considered themselves as well-suited agents for quality improvement in general practice, as liaisons between the municipalities and the GPs. Quality improvement in general practice would benefit from a clearer structure in terms of the MCMOs’ roles and responsibilities. Within communicable diseases control, the MCMOs have a clear mandate, which places antimicrobial stewardship initiatives in a favourable position amongst other areas of quality improvement.

• Skow, Marius Andre Hybbestad; Vik, Ingvild & Høye, Sigurd (2020). Antibiotic switch after treatment with UTI antibiotics in male patients. Infectious Diseases. ISSN 2374-4235. 52(6), s. 405–412. doi: 10.1080/23744235.2020.1736329. Fulltekst i vitenarkiv Vis sammendrag

  Background: There is a lack of evidence on treatment of urinary tract infections (UTIs) in male patients in a primary care setting, and whether narrow-spectrum antibiotics are safe and effective. Objectives: To explore antibiotic switch rates after treatment with UTI antibiotics in men over the last 11 years. Material: We analysed data from the Norwegian Prescription Database (NorPD). Men ≥16 years receiving cefalexin, ciprofloxacin, cotrimoxazole, nitrofurantoin, ofloxacin, pivmecillinam or trimethoprim during the period 2008–2018 were included. Antibiotic switch was defined as being prescribed a different antibiotic drug appropriate for UTI within 14 days after initial treatment. We calculated rates of antibiotic switch and corresponding odds ratios for each antibiotic drug. Results: Seven hundred twenty-six thousand and ninety-six (726,096) prescriptions to 429,807 men were defined as possible UTI episodes. Fluoroquinolones, pivmecillinam and cotrimoxazole were most frequently prescribed. Forty-nine thousand five hundred and thirty-one (49,531) (6.8%) of the treatments resulted in antibiotic switch. Compared to cotrimoxazole, the risk of antibiotic switch was higher for pivmecillinam (OR: 2.46; 95% CI, 2.39–2.53) and trimethoprim (OR: 2.12; 95% CI, 2.04–2.20), and lower for fluoroquinolones (OR: 0.40; 95% CI, 0.39–0.42) and cefalexin (OR: 0.28; 95% CI, 0.26–0.30). Treatment duration of ≥7 days and age of ≥50 years were associated with an increased risk of antibiotic switch. Conclusion: Fluoroquinolones and cefalexin were associated with lower antibiotic switch rates than the recommended UTI antibiotics (pivmecillinam, nitrofurantoin and trimethoprim). However, the rates of antibiotic switch following treatment of male patients with first-line empirical UTI antibiotics are relatively low, indicating that the current guidelines are safe.

• Sunde, Marthe; Nygaard, Marthe Marie & Høye, Sigurd (2019). General Practitioners’ Attitudes toward Municipal Initiatives to Improve Antibiotic Prescribing — A Mixed-Methods Study. Antibiotics. 8(3), s. 1–8. doi: 10.3390/antibiotics8030120. Fulltekst i vitenarkiv Vis sammendrag

  Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities’ Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs’ views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.

• Walle-Hansen, Marte & Høye, Sigurd (2018). Geographic Variation in Antibiotic Consumption- Is It Due to Doctors' Prescribing or Patients' Consulting? Antibiotics. 7(1). doi: 10.3390/antibiotics7010026. Fulltekst i vitenarkiv Vis sammendrag

  Antibiotic consumption varies greatly between Norwegian municipalities. We examine whether this variation is associated with inhabitants’ consultation rates or general practitioners’ (GP) prescription rates. Our study comprises consultations and antibiotic prescriptions for respiratory tract infections (RTIs) in general practice in all Norwegian municipalities with over 5000 inhabitants in 2014. Data was collected from The Norwegian Prescription Database, The Directorate of Health’s system for control and payment of health reimbursements registry and Norway Statistics. Consultation rates and prescription rates were categorised in age- and gender specific quintiles and the effect on antibiotic consumption was analysed using a Poisson regression model. We found that inhabitants with RTIs received 42% more prescriptions if they belonged to a municipality with high consultation rates compared to low consultation rates [incidence rate ratio (IRR) 1.42 (95% CI 1.41–1.44)] and 48% more prescriptions if they belonged to a municipality with high prescription rates versus low prescription rates [IRR 1.48 (95% KI 1.47–1.50)]. Our results demonstrate that inhabitants’ consultation rates and GPs’ prescription rates have about equal impact on the number of RTI antibiotics prescribed at municipality level. These findings highlight the importance of interventions targeting patients as well as doctors in efforts to reduce unnecessary antibiotic consumption.

• Skarpeid, Philip Lawrence & Høye, Sigurd (2018). Phenoxymethylpenicillin Versus Amoxicillin for Infections in Ambulatory Care: A Systematic Review. Antibiotics. 7(3). doi: 10.3390/antibiotics7030081. Fulltekst i vitenarkiv Vis sammendrag

  Most antibiotics are prescribed in primary care, and commonly for respiratory tract infections (RTIs). Narrow-spectrum phenoxymethylpenicillin is the antibiotic of choice for RTIs in the Scandinavian countries, while broader spectrum amoxicillin is used in most other European countries. This review summarizes the knowledge of the effect of phenoxymethylpenicillin versus amoxicillin for infections treated in ambulatory care. We searched PubMed/Medline and Embase for trials comparing the clinical effect of phenoxymethylpenicillin and amoxicillin. The Norwegian Knowledge Centre for the Health Services’ checklist was used to assess risk of bias. In total, 1687 studies were identified, and 18 of these fulfilled the inclusion criteria. One additional study was found as a reference. The randomized controlled trials revealed no significant differences in clinical effect in acute sinusitis (three RCTs), GAS tonsillitis (11 RCTs) and Lyme borreliosis (two RCTs). One RCT on community-acquired pneumonia found amoxicillin to be superior, while the results were conflicting in the two RCTs on acute otitis. The results suggest that non-Scandinavian countries should consider phenoxymethylpenicillin as the treatment of choice for RTIs because of its narrower spectrum. More studies should be conducted on the clinical effect of phenoxymethylpenicillin versus amoxicillin for acute otitis and lower RTIs.

• Blix, Hege Salvesen; Høye, Sigurd; Blandhol, Mari & Tysland, Thekla (2017). Antibiotic switch during treatment with antibiotics against respiratory tract infections in ambulatory care in Norway. Infectious Diseases. ISSN 2374-4235. 49(11-12), s. 854–858. doi: 10.1080/23744235.2017.1350879. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Gjelstad, Svein; Foshaug, Mats & Høye, Sigurd (2017). Antibiotic prescribing for acute respiratory tract infections in Norwegian primary care out-of-hours service. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 35(2), s. 178–185. doi: 10.1080/02813432.2017.1333301. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To examine factors correlating with antibiotic prescribing for acute respiratory tract infections (ARTIs) in Norwegian primary care out-of-hours service. Materials and methods: Retrospective data analysis for the year 2014 in two out-of-hours primary care units located in the towns of Hamar and Tønsberg in Norway, analysing type and frequency of different antibiotics prescribed by 117 medical doctors for ARTIs, and factors correlating with these. Results: The 117 doctors in two out-of-hours units diagnosed 6757 cases of ARTIs. 2310 (34.2%) of these resulted in an antibiotic prescription, where of 1615 (69.9%) were penicillin V (PcV). Tonsillitis and sinusitis were the two ARTI diagnoses with the highest antibiotic prescription rate. The antibiotic prescription rate increased successively with increasing activity level, measured as shorter median duration of consultations per session, from 28.7% (reference) in the least busy quintile of sessions to 36.6% (OR: 1.38 (95% CI =1.06–1.80)) in the busiest quintile of sessions. Prescribing of broad-spectrum antibiotics was not correlated with median duration of consultations per session. Female doctors had an OR of 0.61 (0.40–0.92) of a broad-spectrum antibiotic prescription compared to their male colleagues. Conclusions: Antibiotic prescribing for ARTIs in the primary care out-of-hours services investigated is at the same level as in Norwegian general practice, but with a higher prescription rate of PcV. Antibiotic prescribing increases on busy sessions, measured as median duration of consultations per session. The work frame in primary care out-of-hours service might influence the quality of clinical decisions.

• Nordeng, Stina; Nordeng, Hedvig Marie Egeland & Høye, Sigurd (2016). Bruk av antibiotika i svangerskapet. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(4), s. 317–321. doi: 10.4045/tidsskr.15.0451. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Høye, Sigurd; Fossum, Guro Haugen & Emilsson, Louise (2026). Acute sinusitis – quo vadis? Fulltekst i vitenarkiv Vis sammendrag

  Acute sinusitis (AS) is a frequent reason for primary care visits and has historically been a major cause of unnecessary antibiotic prescribing, contributing significantly to antimicrobial resistance (AMR). This symposium presents findings from the Norwegian BASIC (Better treatment for Acute Sinusitis In primary health Care) project, which addresses AMR and promotes sustainability by tackling diagnostic uncertainty, evaluating treatment alternatives, and studying patient and prescriber expectations. The central theme is the shifting landscape of AS management: while Norway has succeeded in substantially reducing antibiotic use, clinical decision-making remains complex, driven by patient-reported symptoms rather than clear guidelines. Aim of the symposium The overarching purpose of this symposium is to contribute to an improved understanding and management of acute sinusitis (AS) in Nordic general practice. The symposium will provide clinically useful information by presenting the newest evidence regarding appropriate AS management, thereby enhancing patient care. For the academic audience, the symposium offers academically valuable insights by detailing the innovative research methodology utilized in the BASIC project. Titles of Presentations included in the symposium Sinusitis – a vanishing entity? Introduction, 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo 'Antibiotics Works': Patient and GP experiences and expectations 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo Less antibiotics – more complications? 15 min. Louise Emilsson, associate professor, Department of General Practice, University of Oslo If not antibiotics – what then? 15 min Guro Haugen Fossum, researcher and head of research group, Department of General Practice, University of Oslo

• Renaa, Therese; Fossum, Guro Haugen; Høye, Sigurd; Skow, Marius & Emilsson, Louise (2026). Rate of otitis complications with lower antibiotic prescribing to preschool children in general practice. Nordic Congress of General Practice : Abstracts. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Antibiotic prescribing for otitis decreased in Norway from 2012 to 2019. Diagnosing otitis in young children is challenging, and the consistently high antibiotic prescription rate indicates a low threshold for antibiotic treatment in general practice, likely driven by diagnostic uncertainty and concern for complications. Aim To investigate if the rate of severe complications increases when fewer children with otitis are treated with antibiotics. Methods Registry study based on population data combined from four different health registries: KUHR (The Norwegian control and reimbursement registry), SSB (Norwegian statistics), NPR (The National Patient Registry), and NorPD (the Norwegian prescription registry). Multivariate logistic regressions tested associations of antibiotic treatment for otitis with hospitalization and severe complications, adjusted for demographic factors, underlying illness, health care access and the general practitioners (GP’s) prescription patterns. Severe complications included sinus venous thrombosis, mastoiditis, pneumonia, meningitis and sepsis. Results Preliminary results indicated that of 269,003 otitis episodes, only 300 resulted in a severe complication, 0.1%. Pneumonia and mastoiditis were the most common severe complications. The rate of severe complications changed minimally from 2012 (9/10 000 episodes) to 2019 (11/10 000 episodes), while the antibiotic prescription rate decreased by 21%. Asthma (OR 2.05 CI 1.54 – 2.75) and Down syndrome/craniofacial anomaly (OR 2,63 CI 1.08 – 6.40) gave the highest OR for severe complications among pre-existing conditions. The risk of complications was the same for children treated by low-prescribing GPs as high-prescribing GP’s. Conclusions and clinical implication Severe complications of otitis are rare. There was observed no increase in the rate of complications with lower antibiotic prescription.

• Heltveit-Olsen, Silje Rebekka; Brækhus, Leni Aurora & Høye, Sigurd (2025). (+) Studie: Legemiddel som ikke gir resistens, forebygger urinveisinfeksjoner hos eldre. Dagens medisin. ISSN 1501-4290. Fulltekst i vitenarkiv Vis sammendrag

  Et gammelt, billig og mye brukt legemiddel har manglet god dokumentasjon, men er nå undersøkt i en norskledet studie, som er gjennomført i allmennpraksis i fire land.

• Lindberg, Bent Håkan; Skow, Marius & Høye, Sigurd (2025). Point-of-care white blood cell count – a tool for improved antibiotic prescribing? Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Solbakken, Erika & Høye, Sigurd (2025). Bruk-Spar-Reserve i skandinavisk primærhelsetjeneste. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: https:/tidsskriftet.no/2025/06/kommentar/bruk-spar-reserve-i-skandinavisk-primaerhelsetjeneste#comment-3511. Fulltekst i vitenarkiv
• Skow, Marius; Emilsson, Louise; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Fossum, Guro Haugen (2024). BIHULEBETENNELSE I ALLMENNPRAKSIS: PÅVIRKER ANTIBIOTIKA RISIKOEN FOR LANGVARIGE OG KOMPLISERTE PASIENTFORLØP? Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Akutt bihulebetennelse er en vanlig tilstand i allmennpraksis, hvor antibiotika ofte foreskrives, til tross for økende dokumentasjon som viser at ukompliserte tilfeller sjelden har nytte av slik behandling. Risikoen for alvorlige komplikasjoner er lav, og tidligere studier fra norsk allmennpraksis har ikke vist noen vesentlig beskyttende effekt av antibiotika når det gjelder å forhindre sykehusinnleggelser eller alvorlige komplikasjoner etter akutt bihulebetennelse. Denne studien fokuserer på såkalte milde komplikasjoner av akutt bihulebetennelse, med vekt på antall konsultasjoner i allmennpraksis, bruk av spesialisthelsetjenester, sykefravær og antibiotikabruk. Målet med studien er å undersøke forekomsten av forlengede og kompliserte pasientforløp ved akutt bihulebetennelse som behandles utenfor sykehus, og å sammenligne utfallet blant pasienter som behandles med antibiotika, med de som ikke gjør det. Metode: Ved å koble data fra flere nasjonale helseregistre, analyserer vi episoder av akutt bihulebetennelse hos voksne pasienter diagnostisert i allmennpraksis i perioden 2012–2019. For hver episode samler vi inn opplysninger om antibiotikaresepter, legekonsultasjoner, sykemeldinger og kontakter hos øre-nese-hals-spesialister og poliklinikker. Vi bruker en «difference-in-difference»-metode for å sammenligne utfallet av episoder behandlet med og uten antibiotika, ved å undersøke forekomsten av de ulike utfallsmålene i 12 uker etter en akutt bihulebetennelsesepisode, sammenlignet med 12 uker før episoden. Resultater: Vår kohort består over 600 000 episoder av akutt bihulebetennelse. Analysene er ikke ferdige på tidspunktet for innsending av sammendraget, men foreløpige resultater vil bli presentert på møtet. Konklusjoner: Konklusjonene er foreløpig ikke klare og vil bli trukket basert på den endelige analysen av våre data.

• Skow, Marius Andre Hybbestad; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Fulltekst i vitenarkiv
• Skow, Marius; Emilsson, Louise; Straand, Jørund; Høye, Sigurd & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Fulltekst i vitenarkiv
• Heikkilä, Reino; Høye, Sigurd; Gjersvik, Petter & Hem, Erlend (2023). Uttrykket watchful waiting bør unngås. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(2), s. 1–3. doi: 10.4045/tidsskr.22.0581. Fulltekst i vitenarkiv
• Renaa, Therese; Emilsson, Louise; Skow, Marius; Høye, Sigurd & Fossum, Guro Haugen (2023). Antibiotic prescriptions to preschool children with respiratory tract infections in Norwegian primary health care 2012-2019. Fulltekst i vitenarkiv
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Luftveisinfeksjoner og antibiotikaforskrivning i allmennpraksis. Fulltekst i vitenarkiv
• Thaulow, Jorunn; Eide, Torunn Bjerve; Høye, Sigurd & Skjeie, Holgeir (2023). Decisions regarding antibiotic prescribing for acute sinusitis in Norwegian general practice. A qualitative focus group study. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Høye, Sigurd & Brækhus, Leni Aurora (2023). Studie: Halverte bruken av urinveisantibiotika hos eldre uten at det gikk ut over pasientsikkerheten. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria Lyche; Heltveit-Olsen, Silje Rebekka; Høye, Sigurd; Rørtveit, Guri & Straand, Jørund (2022). CovidNor - The Patient Study. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2022). Legevaktsykepleier – portvakt eller serviceyter? Fulltekst i vitenarkiv
• Gjersvik, Petter; Høye, Sigurd & Flottorp, Signe Agnes (2022). Benchmarking =normsammenligning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(8). doi: 10.4045/tidsskr.22.0003. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2022). Can an educational intervention for telephone triage nurses influence the number of RTI-patients in out-of-hours services? Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: A longitudinal interview study. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2022). Can telephone triage nurses influence a population’s out-of-hours attendance? A biangular approach. Fulltekst i vitenarkiv
• Thaulow, Jorunn; Eide, Torunn Bjerve; Høye, Sigurd & Skjeie, Holgeir (2022). Avgjørelser knyttet til bruk av antibiotika mot sinusitt i Norsk allmennpraksis. En kvalitativ fokusgruppe studie. Preliminære resultater. Fulltekst i vitenarkiv
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2022). Antibiotic treatment of adult patients with respiratory tract infections in Norwegian general practice: A nationwide registry-based study. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2022). Changing a population’s health seeking behaviour out-of-hours – a task for telephone triage nurses? Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2021). Assessing respiratory tract infections out-of-hours - the tightrope walks of phone triage nurses. A qualitative study. Fulltekst i vitenarkiv
• Høye, Sigurd (2021). Bedre grunnlag for bærekraftig antibiotikabruk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.21.0443. Fulltekst i vitenarkiv
• Høye, Sigurd & Lindbæk, Morten (2021). Antibiotikasenteret for primærmedisin - kort vei fra forskning til forbedring av klinisk praksis. LVS-info. s. 5–9. Fulltekst i vitenarkiv
• Eig, Ruth Davey & Høye, Sigurd (2020). Varighet av antibiotikakurer i allmennpraksis - kort er godt? Utposten. ISSN 0800-5680. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Heltveit-Olsen, Silje Rebekka & Høye, Sigurd (2020). Experiences of patients and primary health care professionals during the COVID-19 epidemic in Norway. Fulltekst i vitenarkiv
• Martiniussen, Erik & Høye, Sigurd (2020). Kan koronaen bli et vendepunkt også for antibiotikaresistens? Fulltekst i vitenarkiv
• Høye, Sigurd; Lindbæk, Morten & Blix, Hege Salvesen (2019). Effects of an easy-to-implement, sustainable antimicrobial stewardship intervention in primary care – the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria; Høye, Sigurd & Minge, Christina (2019). European Treatment Guidelines for Otitis, Sinusitis and Tonsillitis in Primary Care. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen & Høye, Sigurd (2018). Effect of a Clinical Training Program on Respiratory Tract Infections for Phone Triage Nurses in Out-of-hours Primary Care Centres. Fulltekst i vitenarkiv
• Høye, Sigurd (2018). How to use less and more optimal antibiotics. Fulltekst i vitenarkiv
• Høye, Sigurd (2018). Disse kommunene bruker minst og mest antibiotika. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Høye, Sigurd (2018). Antibiotikabruk i primærhelsetjenesten - hva kan kommuneoverlegen gjøre? Fulltekst i vitenarkiv
• Høye, Sigurd (2018). Enkle grep reduserte bruken av antibiotika med femten prosent. [Journal]. Apollon. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Antibiotikabruk i primærhelsetjenesten. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Antibiotikabruk i primærhelsetjenesten. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Antibiotikabruk i legevakt. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). "Riktigere antibiotikabruk i kommunene" - kommer snart til ditt fylke. Utposten. ISSN 0800-5680. 46(7), s. 16–19. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan; Gjelstad, Svein; Foshaug, Mats & Høye, Sigurd (2017). Antibiotic prescribing for acute respiratory tract infections in Norwegian primary care out-of-hours service. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Har du bronkitt? [Internet]. ABC Nyheter. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Myteknusing tar tid / Myth-busting takes time. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(10), s. 680–680. doi: 10.4045/tidsskr.17.0330. Fulltekst i vitenarkiv
• Høye, Sigurd (2017). Kommunens antibiotikabuk - hva kan smittevernansvarlig kommunelege bidra med? Fulltekst i vitenarkiv
• Høye, Sigurd (2016). Ta dette og et det! : hva er likheten mellom en tablett og en oblat? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(5), s. 375–375. doi: 10.4045/tidsskr.16.0225. Fulltekst i vitenarkiv
• Lindberg, Bent Håkan & Høye, Sigurd (2016). Antibiotika-forskrivning ved akutte luftveisinfeksjoner på interkommunal legevakt. Fulltekst i vitenarkiv
• Høye, Sigurd (2015). Uvanlig om det vanlige. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(12/13), s. 1147–1148. doi: 10.4045/tidsskr.15.0630. Fulltekst i vitenarkiv
• Høye, Sigurd (2015). Bak lukkede dører. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(17), s. 1527–1527. doi: 10.4045/tidsskr.15.0963. Fulltekst i vitenarkiv
• Høye, Sigurd (2015). Kommuniserbar sykdom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(3), s. 209–209. doi: 10.4045/tidsskr.15.0149. Fulltekst i vitenarkiv
• Høye, Sigurd (2014). Ikke spør legen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(14), s. 1341–1341. doi: 10.4045/tidsskr.14.0864. Fulltekst i vitenarkiv
• Høye, Sigurd (2014). Allmennlegen – hipp hurra og nam nam! Per Fugelli intervjuet av Sigurd Høye. [Journal]. Utposten - blad for allmenn- og samfunnsmedisin. Fulltekst i vitenarkiv
• Høye, Sigurd (2013). Heller sprettert enn kanon. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 133, s. 2117–2117. Fulltekst i vitenarkiv
• Simonsen, Gunnar Skov; Blix, Hege Salvesen; Helgesen, Kari Marie Olli; Urdahl, Anne Margrete; Afset, Jan Egil & Andersen, Cecilie Torp [Vis alle 23 forfattere av denne artikkelen] (2026). NORM/NORM-VET 2025 : Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Folkehelseinstituttet. Fulltekst i vitenarkiv
• Simonsen, Gunnar Skov; Blix, Hege Salvesen; Helgesen, Kari Marie Olli; Urdahl, Anne Margrete; Afset, Jan Egil & Andersen, Cecilie Torp [Vis alle 23 forfattere av denne artikkelen] (2025). NORM/NORM-VET 2024. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Veterinærinstituttet. doi: https:/www.vetinst.no/overvaking/antibiotikaresistens-norm-vet/_/attachment/inline/78155e88-2b2e-42a1-ac0c-b06071eb0479:21bb52d0f6c051c93f0d4a0605eb001e25e7fe99/NORM%20NORM-VET%202023%20(2).pdf. Fulltekst i vitenarkiv
• Gunnes, Mari; Thaulow, Kristin; Sand, Kari; Ingvaldsen, Jon Espen; Kille, Benjamin Uwe & Høye, Sigurd [Vis alle 7 forfattere av denne artikkelen] (2025). AIFAL-prosjekt: Allmennlegers perspektiv på muligheter og begrensninger ved bruk av KI på fastlegekontoret. SINTEF Digital. ISSN 9788214074208. Fulltekst i vitenarkiv Vis sammendrag

  I prosjektet Allmennlegers perspektiv på muligheter og begrensninger ved bruk av AI på fastlegekontoret (AIFAL-prosjekt) har vi utforsket allmennlegenes perspektiv på bruk av kunstig intelligens (KI) og generative språkmodeller i allmennpraksis for å kunne bidra til utvikling av KI-løsninger som er relevante, nyttige og skreddersydde for norsk allmennpraksis. Data ble innsamlet på en heldags workshop med 11 allmennleger der vi bl.a. gjennomførte to fokusgruppeintervjuer. Allmennlegene som deltok i workshopen uttrykte både forventning og skepsis til bruk av KI-basert teknologi i sin arbeidshverdag. De har erfaring med eller ideer om hvordan KI kan effektivisere og øke kvaliteten på mange arbeidsoppgaver, og er samtidig opptatt av å bevare klinisk skjønn og pasientsikkerhet. De ønsker seg bekreftelser på og støtte for at teknologien er trygg å bruke i klinisk praksis.

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