Researchers at McMaster University have developed and released new recommendations to improve how antibiotics are prescribed across Canada, marking a significant milestone in the country’s fight against antimicrobial resistance (AMR) — a phenomenon through which antimicrobial medications, like antibiotics, stop working as intended.
The new guidance, commissioned by the Public Health Agency of Canada (PHAC) in 2024, is designed to promote more prudent antibiotic use under the stewardship pillar of Canada’s broader AMR strategy, as outlined in the Pan-Canadian Action Plan on AMR.
Known as the Canadian Antibiotic Treatment Guidance, the new resource is now available to prescribers and other health professionals nationwide via Firstline, a Canadian health technology platform.
“Publishing the recommendations this way allows us to get them directly to the patient bedside,” explains Deborah Yamamura, a professor in McMaster’s Department of Pathology & Molecular Medicine and a member of the Michael G. DeGroote Institute for Infectious Disease Research (IIDR). “Family physicians, nurse practitioners, pharmacists, internists, and others will all have immediate, on-demand access to this new, evidence-based guidance.”
Yamamura, who led the development of the new recommendations during her time as President of the Association of Medical Microbiology and Infectious Disease (AMMI) Canada, says the guidance was intentionally designed to reflect the Canadian context: it focuses on antibiotics that are approved for use in Canada, it is informed by Canadian epidemiology, and it considers Canada’s own regional resistance rates.
Much of this work was carried out in collaboration with fellow McMaster Health Sciences faculty members Mark Loeb and Dena Zeraatkar.
Zeraatkar, an assistant professor in McMaster’s departments of Anesthesia and Health Research Methods, Evidence, and Impact (HEI), says that the new prescribing guidance is not only a Canadian-first, but is also among the first of its kind anywhere in the world.
“There are few antibiotic guidelines that exist anywhere that were developed as systematically and as transparently as these new ones are,” she says.
Working with a panel of Canadian infectious disease physicians, medical microbiologists, pharmacists, family physicians, pediatricians, preventative medicine specialists, and public health officials, the research team employed the GRADE-ADOLOPMENT approach to developing the new recommendations. This approach — which itself was developed at McMaster — systematically combines methods of adoption, adaptation, and creation in the development of new health guidelines.
The panel began with a comprehensive review of antibiotic prescribing guidelines from around the world, which were then assessed for relevance to the Canadian context. Among the most influential sources was the World Health Organization’s (WHO) recently published standards for antibiotic usage — new international guidelines that Loeb helped develop.
“Using this approach, the WHO recommendations were either adopted, adapted, or changed entirely to fit the Canadian context,” says Loeb, a professor of Pathology & Molecular Medicine at McMaster and a member of the IIDR.
Although the new recommendations directly support Canada’s efforts against AMR, the research team emphasized patient safety and clinical outcomes as their top priorities during development.
The goal, Yamamura says, was simply to support prescribers in making evidence-based treatment decisions that benefit individual patients, which itself will lead to better stewardship of antibiotics.
“Above all else, we wanted to help ensure that prescribers are choosing the most appropriate empiric treatment course for patients and for the appropriate duration,” Yamamura explains. “In doing so, these recommendations will also help decrease AMR in Canada.”
The first slate of recommendations focuses on the treatment of respiratory tract infections, including pharyngitis, pneumonia, COPD, and bronchitis; however, the researchers say comprehensive new treatment guidance for several other syndromes will be added on a rolling basis throughout the year.