Objectives Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems.
Methods We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence.
Results We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines.
Discussion Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required.
PROSPERO registration number CRD42020145235.
- Antimicrobial resistance
- respiratory tract infections
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. No additional data available.
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Contributors RSM, HS, NS, ML and TP designed the study protocol. RSM coordinated the study. RSM, AB, AD, GPM, MV, SK and TB assessed eligibility of records at title and abstract. RSM, AD and MV searched for unpublished guidelines in key websites. RSM, AB, AD, GPM, MV, and SK assessed eligibility of full text articles. RSM, AB, AD, FS, GPM, MV and SK extracted data and performed quality assessment using the AGREE II tool. NS and HS settled disputes. RSM analysed and interpreted the data with HS, NS and ML. RSM and HS drafted the manuscript, with writing contributions from NS, ML and LM. All authors interpreted and make edits to the manuscript.
Funding Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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