More than half of recommendations included in guidelines from the Infectious Diseases Society of America rely on low-quality evidence, according to a study in the Archives of Internal Medicine.
Researchers examined 41 guidelines published by IDSA since 1994. Of the 4200 individual recommendations in those guidelines, 55% were supported by level III quality of evidence (e.g., expert opinions), while only 14% were guided by level I evidence (e.g., randomized controlled trials).
Five guidelines were updated during the study interval. In these updates, the number of recommendations increased between 20% and 400%, but only two updates saw an increase in the number of recommendations based on high-quality evidence.
An editorialist said that one of the main take-home messages of this study "is to be wary of falling into the trap of 'cookbook medicine.' The existence of guidelines is probably better than no guidelines, but guidelines will never replace critical thinking in patient care."
Reference: Khan AR, Khan S, Zimmerman V, Baddour LM and Tleyjeh IM. Quality and Strength of Evidence of the Infectious Diseases Society of America Clinical Practice Guidelines. Clinical Infectious Diseases 2010;51:1147-1156.
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