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Methodology
AbxGuide team developed an initial list of priority pathogens and a standardized template for compiling data, that was tested and adapted following internal consultation.
The development of the AbxGuide database was informed by a review of treatment guidelines for adults published by the international societies, regional technical bodies and specialized agencies. The guidance for each organ system, syndrome or pathogen was compiled from at least three and most often five or more sources. The list of sources can be found here.
The review of treatment guidelines was performed between March 2022 and May 2023. The compiled data was internally reviewed and agreed upon by consensus of four experts. The guide then underwent an external peer review in which for every syndrome two independent experts reviewed the guidance based on their expertise and experience. The list of team experts and external peer reviewers can be found here.
To make sure the Guide adheres to the global objective of country-level target of at least 60% of used antibiotics are from Access category, the terminology and classification are aligned with the WHO AWaRe classification 2021, using the same colour-coding to reflect the category of the antibiotic.
For succinctness, some commonly used terms are presented as abbreviations. The full list can be found here.
Data sources
Community-acquired pneumonia:
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the ATS and IDSA. Am J Respir Crit Care Med 2019; 200(7):e45–e67.
Huttner B, Cappello B, Cooke G, et al. (2019) Community-acquired Pneumonia Treatment Guidelines: There Is a Need for a Change toward More Parsimonious Antibiotic Use. American Journal of Respiratory and Critical Care Medicine. 2020 May;201(10):1315-1316. DOI: 10.1164/rccm.201911-2226le. PMID: 32069065; PMCID: PMC7233347.
Africa Centres for Disease Control and Prevention and Center for Disease Dynamics, Economics & Policy. (2021). African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes- First Edition. Addis Ababa, Ethiopia. https://africaguidelines.cddep.org/wp-content/uploads/2021/11/Guidelines_Adults_Peds_English.pdf
Uptodate: Overview of community-acquired pneumonia in adults, retrieved on 15 June 2022 from https://www.uptodate.com/contents/overview-of-community-acquired-pneumonia-in-adults
Hospital-acquired pneumonia:
IDSA guidelines on treatment of Antimicrobial Resistant Gram-negative infections: Version 1.0 (7 Mar 2022), retrieved on 15 June 2022 from https://www.idsociety.org/practice-guideline/amr-guidance/
IDSA Guidelines: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society (14 July 2016), retrieved on 15 June 2022 from https://www.idsociety.org/practice-guideline/hap_vap/
Torres, Antoni, et al. "International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)." European Respiratory Journal 50.3 (2017).
African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes, First Edition (2021), Retrieved June 15, 2022, from https://africacdc.org/african-antibiotic-treatment-guidelines-for-common-bacterial-infections-and-syndromes/
UptoDate: Treatment of hospital-acquired and ventilator-associated pneumonia in adults, available at: https://www.uptodate.com/contents/treatment-of-hospital-acquired-and-ventilator-associated-pneumonia-in-adults/print (accessed: 8 May 2023)
Bassetti, Matteo, et al. "Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): a randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial." The Lancet Infectious Diseases 21.2 (2021): 226-240.
Bassetti, M, Peghin M. "How to manage KPC infections." Therapeutic Advances in Infectious Disease 7 (2020): 2049936120912049.
https://journals.sagepub.com/doi/pdf/10.1177/2049936120912049
Urinary tract infections:
IDSA guidelines on treatment of Antimicrobial Resistant Gram-negative infections: Version 1.0, 7/3/2022, Retrieved on 15 June 2022 from https://www.idsociety.org/practice-guideline/amr-guidance/
EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, the Netherlands 2022. ISBN 978-94-92671-16-5. Online version available at: https://uroweb.org/guidelines/urological-infections (accessed: 5 May 2023)
NICE guideline (Urinary tract infection (lower): antimicrobial prescribing), published October 2018, retrieved on 15 June 2022 from https://www.nice.org.uk/guidance/ng109
African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes, First Edition (2021), Retrieved June 15, 2022, from https://africacdc.org/african-antibiotic-treatment-guidelines-for-common-bacterial-infections-and-syndromes/
Uptodate Resource page on UTIs: https://www.uptodate.com/contents/table-of-contents/nephrology-and-hypertension/urinary-tract-infections (accessed: 8 May 2023)
Meningitis:
Allan R. Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L. Kaplan, W. Michael Scheld, Diederik van de Beek, Thomas P. Bleck, Hugh J.L. Garton, Joseph R. Zunt, 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis, Clinical Infectious Diseases, Volume 64, Issue 6, 15 March 2017, Pages e34–e65, https://doi.org/10.1093/cid/ciw861
Sigfrid, L., Perfect, C., Rojek, A. et al. A systematic review of clinical guidelines on the management of acute, community-acquired CNS infections. BMC Med 17, 170 (2019).https://doi.org/10.1186/s12916-019-1387-5
D. van de Beek et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis, Clinical Microbiology and Infection, Volume 22, Supplement 3, 2016, Pages S37-S62, https://doi.org/10.1016/j.cmi.2016.01.007
UptoDate: Clinical features and diagnosis of acute bacterial meningitis in adults, available at: https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults (accessed: 10 May 2023)
McGill, F. (2021, February 18). The UK Joint Specialist Societies Guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. UK Health Security Agency.
McCreary EK, Byers KE, Fernandes C, Kline EG, Nicolau DP, Shields RK. Plasma and Cerebrospinal Fluid Therapeutic Drug Monitoring of Ceftolozane and Tazobactam During Treatment of Multidrug-Resistant Pseudomonas aeruginosa Meningitis. Open Forum Infect Dis. 2020 Nov 12;7(12):ofaa549. doi: 10.1093/ofid/ofaa549. PMID: 33409327; PMCID: PMC7751399.
Kim BN, Peleg AY, Lodise TP, et al. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis. 2009;9(4):245-255. doi:10.1016/S1473-3099(09)70055-6, Retrieved 8 May, 2023, from: https://pubmed.ncbi.nlm.nih.gov/19324297/
Dhariwal, A., Leff, R., Allen, M., & Cherian, B. (2022). Intrathecal daptomycin use in a challenging case of enterococcus faecium ventriculitis. Access Microbiology, 4(4). https://doi.org/10.1099/acmi.0.000230
Skin and soft tissue infections:
Dennis L. Stevens, A. L. B. (2014, July 15). Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. idsociety.org. Retrieved June 15, 2022, from https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/
Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America Antimicrobial-Resistant Treatment Guidance: Gram-Negative Bacterial Infections. Infectious Diseases Society of America 2022; Version 1.1.
Sartelli, M., Coccolini, F., Kluger, Y. et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg 17, 3 (2022). https://doi.org/10.1186/s13017-022-00406-2
African Antibiotic Treatment Guidelines for Common Bacterial Infections and Syndromes, First Edition (2021), Retrieved June 15, 2022, from https://africacdc.org/african-antibiotic-treatment-guidelines-for-common-bacterial-infections-and-syndromes/
Jabbour JF, Kanj SS. Gram-Negative Skin and Soft Tissue Infections. Infect Dis Clin North Am. 2021 Mar;35(1):157-167. doi: 10.1016/j.idc.2020.10.008. Epub 2020 Dec 7. PMID: 33303333.
UptoDate resource page on SSTI, available at: https://www.uptodate.com/contents/suspected-staphylococcus-aureus-and-streptococcal-skin-and-soft-tissue-infections-in-children-greater-than28-days-evaluation-and-management (accessed: 5 May 2023)
Hindy JR, Haddad SF, Kanj SS. New drugs for methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Curr Opin Infect Dis. 2022 Apr 1;35(2):112-119. doi: 10.1097/QCO.0000000000000800. PMID: 34812745.
Golan Y. Current Treatment Options for Acute Skin and Skin-structure Infections. Clin Infect Dis. 2019;68(Suppl 3):S206-S212. doi:10.1093/cid/ciz004
Fritzenwanker M, Imirzalioglu C, Herold S, Wagenlehner FM, Zimmer KP, Chakraborty T. Treatment Options for Carbapenem- Resistant Gram-Negative Infections. Dtsch Arztebl Int. 2018 May 21;115(20-21):345-352. doi: 10.3238/arztebl.2018.0345. PMID: 29914612; PMCID: PMC6172649.
Abbreviations used in the AbxGuide
| BLNAR | beta-lactamase negative, amoxicillin resistant |
| BL/BLI | beta-lactamase/beta-lactamase inhibitor |
| BPH | benign prostatic hyperplasia |
| CAP | community-acquired pneumonia |
| CAUTI | catheter-associated UTI |
| CMS | colistimethate sodium |
| CRE | carbapenem-resistant enterobacterales |
| DDI | drug-drug interaction |
| DS | double strength |
| DTR | difficult-to-treat |
| EI | extended infusion |
| ESBL | extended-spectrum beta-lactamase |
| GU | genito-urinary |
| HAP | hospital-acquired pneumonia |
| IC | immunocompromised (patient) |
| IM | intramuscular (administration) |
| IT | intrathecal (administration) |
| IV | intravenous (administration) |
| IVT | Intraventricular (administration) |
| KPC | Klebsiella pneumoniae carbapenemase |
| MBL | metallobetalactamase |
| MDR | multidrug-resistant |
| MIC | minimal inhibitory concentration |
| MIU | million international units |
| MSSA | methicillin-susceptible S. aureus |
| MRSA | methicillin-resistant S. aureus |
| NDM | New Delhi metallo-beta-lactamase |
| OXA-48 | oxacillinase-48 |
| PDR | pandrug-resistant |
| PO | per os (oral administration) |
| SSRI | selective serotonin reuptake inhibitor |
| SNRI | serotonin and norepinephrine re-uptake inhibitor |
| SSTI | skin and soft tissue infections |
| STI | sexually-transmitted infections |
| TMP/SMX | trimethoprim + sulfamethoxazole |
| UTI | Urinary tract infections |
| XDR | extensively drug-resistant |