Author Affiliations: Section of Infectious Diseases, Department of Internal Medicine (Drs Khan and Tleyjeh) and Research Center (Dr Tleyjeh), King Fahad Medical City, Riyadh, Saudi Arabia; and Division of Infectious Diseases, Department of Internal Medicine Mayo Clinic, Rochester, Minnesota (Dr Baddour).
Lee and Vielemeyer1 reported that approximately one-half of the IDSA guidelines were based on low-level evidence that was largely derived from expert opinion. Their findings concur with our evaluation of the IDSA guidelines, which has been recently published in Clinical Infectious Diseases.2 The process of grading evidence on the basis of hierarchy of study design has been the subject of criticism. We agree with Lee and Vielemeyer1 that it is time that a standard system for synthesizing evidence should be adopted. A GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system has been suggested to provide a better approach to synthesize guidelines.3 In this system, the evidence would not be entirely dependent on study design but would allow value judgments in evaluating evidence in a transparent manner. In fact, IDSA decided in 2008 to adopt a GRADE system for all new guidelines and updates; the first guidelines using this system would appear in 2011.4
Khan AR, Baddour LM, Tleyjeh IM. Evaluation of IDSA Clinical Practice Guidelines: A Call to Re-GRADE Underlying Evidence. Arch Intern Med. 2011;171(15):1401-1404. doi:10.1001/archinternmed.2011.346