Article type
Abstract
Background:
The last national guideline on antibiotic use in Singapore, including for lower urinary tract infections (UTIs), was published in 2005, highlighting the necessity for an updated clinical guideline tailored to the local context.
Objective:
To develop an ACE Clinical Guidance (ACG) on diagnosis and antibiotic management of lower UTIs in Singapore.
Methods:
A systematic and robust methodology was used to appraise the evidence and formulate recommendations (GRADE), while achieving expert consensus through a consensus method (RAND/UCLA appropriateness rating).
A comprehensive review of literature was conducted, supplemented by use of available local data and antimicrobial resistance patterns. There was no consumer involvement.
Results:
Unlike other pharmacological treatments for non-infectious conditions, the selection of antibiotics for empirical treatment heavily relies on local bacterial susceptibility and resistance patterns, for which there was paucity of published local data. As evidence from international trials had limited applicability to the local context, the development of this UTI guideline presented distinct challenges and required unique considerations. Therefore, efforts were made to collaborate with relevant local healthcare institutions and clinicians to obtain available (unpublished) antimicrobial resistance data and understand the practice gaps. The data was supplemented by literature findings to develop the ACG, ensuring the relevance of the recommendations and associated content to the local context. The data was also used by the Expert Group to inform their appropriateness rating of recommendations.
Conclusions:
Collaboration with local healthcare institutions and clinicians to obtain local antimicrobial resistance data overcame the challenges presented by the limited generalisability of international evidence to the local context, and the paucity of relevant published local literature. This enabled the development of evidence-based antibiotic-specific recommendations for the treatment of lower UTI which is relevant to the local setting. A similar approach is recommended for future antibiotics guideline development to ensure the resulting recommendations are applicable to the local practice setting. As this approach is made possible by the availability of local data, there is also a need to advocate for the collection and dissemination of local antimicrobial resistance data.
The last national guideline on antibiotic use in Singapore, including for lower urinary tract infections (UTIs), was published in 2005, highlighting the necessity for an updated clinical guideline tailored to the local context.
Objective:
To develop an ACE Clinical Guidance (ACG) on diagnosis and antibiotic management of lower UTIs in Singapore.
Methods:
A systematic and robust methodology was used to appraise the evidence and formulate recommendations (GRADE), while achieving expert consensus through a consensus method (RAND/UCLA appropriateness rating).
A comprehensive review of literature was conducted, supplemented by use of available local data and antimicrobial resistance patterns. There was no consumer involvement.
Results:
Unlike other pharmacological treatments for non-infectious conditions, the selection of antibiotics for empirical treatment heavily relies on local bacterial susceptibility and resistance patterns, for which there was paucity of published local data. As evidence from international trials had limited applicability to the local context, the development of this UTI guideline presented distinct challenges and required unique considerations. Therefore, efforts were made to collaborate with relevant local healthcare institutions and clinicians to obtain available (unpublished) antimicrobial resistance data and understand the practice gaps. The data was supplemented by literature findings to develop the ACG, ensuring the relevance of the recommendations and associated content to the local context. The data was also used by the Expert Group to inform their appropriateness rating of recommendations.
Conclusions:
Collaboration with local healthcare institutions and clinicians to obtain local antimicrobial resistance data overcame the challenges presented by the limited generalisability of international evidence to the local context, and the paucity of relevant published local literature. This enabled the development of evidence-based antibiotic-specific recommendations for the treatment of lower UTI which is relevant to the local setting. A similar approach is recommended for future antibiotics guideline development to ensure the resulting recommendations are applicable to the local practice setting. As this approach is made possible by the availability of local data, there is also a need to advocate for the collection and dissemination of local antimicrobial resistance data.