RT Journal Article SR Electronic T1 Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e046097 DO 10.1136/bmjopen-2020-046097 VO 11 IS 7 A1 Rosa Stalteri Mastrangelo A1 Nancy Santesso A1 Antonio Bognanni A1 Andrea Darzi A1 Samer Karam A1 Thomas Piggott A1 Tejan Baldeh A1 Finn Schünemann A1 Matthew Ventresca A1 Gian Paolo Morgano A1 Lorenzo Moja A1 Mark Loeb A1 Holger Schunemann YR 2021 UL http://bmjopen.bmj.com/content/11/7/e046097.abstract AB 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.All data relevant to the study are included in the article or uploaded as online supplemental information. No additional data available.