Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on upper respiratory tract infections — rational antimicrobial use

This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for rational antimicrobial use in upper respiratory tract infections (URTIs). Upper respiratory tract infections are one of the most frequent presentations in primary healthcare settings, and they offer a critical opportunity for clinicians to promote antimicrobial stewardship through evidence-based prescribing practices. Utilising Grading of Recommendations Assessment, Development and Evaluation methodology, four evidence-informed recommendations have been formulated to support clinicians in assessing URTIs and making appropriate antimicrobial treatment decisions. This EtR framework synthesises the available evidence base alongside expert consensus to inform the recommendations presented in the ACG, thereby enabling clinicians to better understand the underlying rationale and effectively implement these recommendations within their clinical practice when managing URTIs and considering antimicrobial therapy. The ACG can be found at https://go.gov.sg/acg-urti.