Table 1

Satisfactory recommendations that consider antimicrobial resistance (AMR) dimensions

AMR dimension(s)RecommendationEvidence illustration
AMR population-level dimensions consideredAmoxicillin-clavulanate rather than amoxicillin alone is recommended as empiric antimicrobial therapy for Acute Bacterial Rhinosinusitis (ABRS) in adults (weak, low).13Local national surveillance data in the United States of America for amoxicillin and beta-lactamase-producing Haemophilus influenzae was narratively described in the evidence summary was clearly linked to the recommendation.
AMR outcome-level dimensions consideredIn neonates with gonococcal conjunctivitis, the WHO sexually transmitted infections (STIs) guideline suggests one of the following treatment options:

  • Ceftriaxone 50 mg/kg (maximum 150 mg) intramuscular (IM) as a single dose.

  • Kanamycin 25 mg/kg (maximum 75 mg) IM as a single dose.

  • Spectinomycin 25 mg/kg (maximum 75 mg) IM as a single dose.89

The outcome of ‘AMR’ was formally considered within a PICO framework within the guideline’s online supplemental file 1.
Population and outcome-level dimensions consideredBedaquiline should be included in longer multidrug-resistant (MDR) TB regimens for patients aged 18 years or more (strong recommendation, moderate certainty in the estimates of effect).90The recommendation considers a multidrug-resistant TB patients, and the outcome ‘acquisition (amplification) of drug resistance’91 was formally considered within a PICO framework provided within the guideline’s supplemental materials.
Alternative first choice of antibiotics for adults aged 18 years and over with pharyngitis and a penicillin allergy or intolerance: Clarithromycin 250 mg to 500 mg wo times per day a day for 5 days days.55Summary of committee discussions show that population-level resistance data was considered: ‘based on evidence, clinical experience and resistance data, the committee agreed to recommend the following alternative first-choice antibiotics for use in penicillin allergy or for phenoxymethylpenicillin intolerance: clarithromycin or erythromycin (which is preferred in pregnancy)’.55 Additional formal outcome considerations include ‘antibiotic resistance’ within the guideline’s supplemental materials.

  • PICO, population, intervention, comparison, and outcome; TB, tuberculosis.