Author Affiliations: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
We welcome the insightful comments by Drs Deresinski and File and agree that in the era of the evidence-based medicine, guidelines have become a key reference for decision making in clinical medicine and often form the basis on which the delivery of best-possible patient care is defined. Our analysis1 along with that of Dr Khan's group2 found a relative paucity of good quality evidence behind current IDSA guidelines (http://www.idsociety.org). We concur that this reflects a lack of good scientific data in the field, rather than an inherent shortcoming of the development process of the guidelines and that “A marked expansion of the infrastructure for infectious disease clinical research is necessary for the improvement of patient care.” The highly successful AIDS Clinical Trial Group is one example that illustrates how networks and collaborative efforts have produced critically needed and scientifically sound research. Similar endeavors should be encouraged and coordinated for all aspects of infectious diseases research across the globe. We believe that, furthermore, a better understanding of the fundamental processes that govern the complex interplay between host and pathogen in disease is also needed. Continued emphasis must thus be placed also on basic and translational research in the field.
Lee DH, Vielemeyer O. Evaluation of IDSA Clinical Practice Guidelines: A Call to Re-GRADE Underlying Evidence—Reply. Arch Intern Med. 2011;171(15):1401-1404. doi:10.1001/archinternmed.2011.347