Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on bacterial skin and soft tissue infections — diagnosis and antibiotic prescribing

This evidence-to-recommendation (EtR) framework underpins the Agency for Care Effectiveness Clinical Guideline (ACG) for bacterial skin and soft tissue infections (SSTIs), providing rationale and justifications for its recommendations on diagnosis and antibiotic prescribing in primary and community care. Based on the Grading of Recommendations Assessment, Development and Evaluation framework, five evidence-based recommendations were developed to guide practitioners in making appropriate decisions on the diagnosis, assessment and management of SSTIs, including cellulitis, erysipelas, impetigo, folliculitis, ecthyma, furuncles, carbuncles and skin abscesses. As SSTIs are a leading indication for use of oral antibiotics in primary care, recommendations focus on principles for prescribing antibiotics for specific bacterial SSTIs, including whether antibiotics are indicated and when to prescribe topical, oral or intravenous formulations. The EtR framework consolidates the evidence and considerations that informed the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability. The ACG can be found at https://go.gov.sg/acg-ssti.