Canadian Antibiotic Treatment Guidance for managing common infections

Researchers at McMaster University in Hamilton, Ontario have designed a new resource to improve how antibiotics are prescribed in Canada. The Canadian Antibiotic Treatment Guidance resource is now available to healthcare professionals across Canada (via mobile app or online) from Firstline (https://firstline.org/canada/), a Canadian health technology platform.1 The resource was commissioned by the Public Health Agency of Canada and involved input from a panel of Canadian infectious disease physicians, medical microbiologists, pharmacists, family physicians, pediatricians, preventative medicine specialists and public health officials. The goal is to ensure that prescribers choose the most appropriate empiric treatment and treatment duration for common infectious diseases, leading to better stewardship of antibiotics.2 Contents of the Canadian Antibiotic Treatment Guidance resourceThe resource currently provides recommendations for the treatment of respiratory tract infections (acute bronchitis, acute sinusitis, pharyngitis, community-acquired pneumonia, chronic obstructive pulmonary disease [COPD]) and eye infections (conjunctivitis) in adults and children. Treatment guidance for several other infections will be added in the future.2 For each infectious disease, information is organized into several categories, with separate sections for adults and children:Definition of the conditionMicrobiology (most common pathogens)DiagnosisEmpiric treatment(s): watchful waiting (when appropriate); first-line and second-line therapies, and recommended duration of treatment. In some situations (e.g., acute bronchitis in adults), antibiotics are not recommended (strong recommendation); clinicians may consider nonantibiotic alternatives (e.g., ibuprofen or acetaminophen, and antitussive agents) for the treatment of symptoms of acute bronchitis.Additional information (e.g., resources from Choosing Wisely Canada, Canadian Medical Association Journal, National Advisory Committee on Immunization, Canadian Antimicrobial Resistance Surveillance System, Penicillin Allergy Assessment, and others).1 The Canadian Antibiotic Treatment Guidance resource also provides key information on 16 different antibiotics. For example, for amoxicillin, the resources lists the Clostridioides difficile risk as “medium,” the oral bioavailability as “good” (70%–90%) and the cost as “low” (< $20/day). For each antibiotic, the following additional information is provided (where applicable): spectrum of activity; dosing (adults and children); general information on adverse effects, major interactions, monitoring, use in pregnancy/breastfeeding, pharmacology, additional information such as administration tips.1Throughout the Canadian Antibiotic Treatment Guidance resource, World Health Organization “AWaRe” (Access, Watch and Reserve) symbols are used to categorize antibiotics:The green “Access” group symbol denotes first- or second-choice antibiotics that offer the best therapeutic value, while minimizing the potential for resistance. Antibiotics in this category found in Canadian Antibiotic Treatment Guidance resource: amoxicillin, amoxicillin/clavulanate, ampicillin, cephalexin, doxycycline, penicillin V and tetracycline.The yellow “Watch” group symbol indicates first- or second-choice antibiotics that are only indicated for a specific limited number of infective syndromes. These antibiotics are more prone to be a target of antibiotic resistance and thus should be prioritized as targets of stewardship programs and monitoring. Antibiotics in this category found in Canadian Antibiotic Treatment Guidance resource: azithromycin, cefotaxime, ceftriaxone, cefuroxime, ciprofloxacin, clarithromycin, levofloxacin, moxifloxacin and tobramycin,The red “Reserve” group should be used as a “last resort” in highly selected patients (life-threatening infections due to multidrug-resistant bacteria). These antibiotics should be closely monitored and prioritized as targets of stewardship programs to ensure their continued effectiveness. Antibiotics in this category currently found in Canadian Antibiotic Treatment Guidance resource: none.1,3 The Canadian Antibiotic Treatment Guidance resource was designed to reflect the Canadian context, focusing on antibiotics that are approved for use in Canada. The contents are informed by Canadian epidemiology, with consideration given to Canada’s regional resistance rates. The new resource will enable family physicians, nurse practitioners, pharmacists, internists and others across Canada to have immediate access to evidence-based guidance on antibiotic prescribing.2 ReferencesCanadian Antibiotic Treatment Guidance. Firstline. (accessed March 2, 2026).Dillon B. McMaster researchers begin rolling out national recommendations for the prescription of antibiotics. February 17, 2026. (accessed March 2, 2026).World Health Organization. AWaRe: WHO antibiotic categorization. (accessed March 2, 2026).

Canadian Antibiotic Treatment Guidance for managing common infections

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