Abstract

Introduction: Aligning National Standard Treatment Guidelines (STGs) with WHO AWaRe Book recommendations where appropriate is a key antimcirobial stewardship goal. Antibiotic recommendations in national STGs vary significantly, creating gaps that require evaluation. Methods: We analysed adult STGs from 24 countries in 6 WHO regions for 11 infections commonly seen across countries in the primary care section of the AWaRe book. These included acute otitis media (AOM), pharyngitis, sinusitis, community-acquired pneumonia (CAP), Chronic Obstructive Pulmonary Disease (COPD), lower urinary tract infections (UTIs), gastroenteritis (bloody and non-bloody), oral and dental infections, skin and soft tissue infections and enteric fever. National STGs were compared to WHO AWaRe recommendations to assess alignment of first-line antibiotic recommendations. Results: 522 different first-line oral antibiotic regimens were collected from the different STGs in 24 countries across 6 WHO regions. Access antibiotics were recommended in 65.7% of regimens, while Watch antibiotics accounted for 34.3% of first-line recommendations globally, with very low recommendations of Reserve antibiotics. The Western Pacific Region (76.4%), Region of the Americas (71.2%), and the South East Asia Region (67.8) showed the highest proportions of Access group antibiotic recommendations, whereas the African Region (58%) showed the lowest. Infection-specific analysis showed significant variation in alignment, with higher alignment for enteric fever, non-bloody gastroenteritis, and cystitis, and lower alignment for community-acquired pneumonia, oral and dental infections, and acute otitis media (p = 0.0089). Conclusion: First-line antibiotic recommendations in adult STGs showed only moderate alignment with WHO AWaRe book treatment guidance, with regional variability. Aligning first-line recommendations with the WHO AWaRe book guidance in primary care would assist with national policy and stewardship programs.