The GUIDE Framework for Evidence-Based Antibiotic Prescribing: Strengthening Antimicrobial Stewardship for the Healthcare Workforce

Antimicrobial resistance (AMR) is a major global health threat, driven in part by inappropriate and prolonged antibiotic use in hospitals. The GUIDE Framework for Evidence-Based Antibiotic Prescribing provides a practical, five-step decision-support model to strengthen antimicrobial stewardship (AMS) and support the healthcare workforce in making proportionate, evidence-based prescribing decisions. The framework integrates the UK “Start Smart Then Focus” approach, the WHO AWaRe antibiotic classification and national treatment guidelines, and is designed to be adaptable across different health system contexts, including low- and middle-income countries. GUIDE (Gather, Urgency, Identify, Define, Evaluate) structures antibiotic decision-making from initial assessment and urgency of treatment, through antibiotic choice and duration, to mandatory 48–72 hour review using the CARES outcomes (Cease, Amend, Refer, Extend, Switch). The document outlines target users (policymakers, prescribers, AMS teams, leaders and educators, and healthcare organisations), practical implementation strategies, suggested indicators for monitoring impact, and policy recommendations. It aims to support countries and institutions in embedding AMS within routine practice, digital systems, and national AMR action plans, thereby preserving antibiotic effectiveness and improving patient outcomes.