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    1 Comment for this article
    Paul Schulz, MD | Norton Healthcare
    I hope we would agree that improved antimicrobial stewardship is imperative due to rapidly developing resistance and the lack of new therapies being developed. One of the biggest barriers to the success of antimicrobial stewardship programs is poor prescribing by providers that do not utilize guidelines (or evidence) and site "studies" such as this one when challenged. A guideline should never be used as "the sole source guiding patient care decisions" but appropriate utilization of a guideline based on available evidence and a group of experts opinion is much better than the non- evidence based, individual non-expert opinions and prescribing that has created the resistance problem we currently face.

    Conflict of Interest: None declared
    Original Investigation
    January 10, 2011

    Analysis of Overall Level of Evidence Behind Infectious Diseases Society of America Practice Guidelines

    Author Affiliations

    Author Affiliations: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.

    Arch Intern Med. 2011;171(1):18-22. doi:10.1001/archinternmed.2010.482

    Background  Clinical practice guidelines are developed to assist in patient care. Physicians may assume that following such guidelines means practicing evidence-based medicine. However, the quality of supporting literature can vary greatly.

    Methods  We analyzed the strength of recommendation and overall quality of evidence behind 41 Infectious Diseases Society of America (IDSA) guidelines released between January 1994 and May 2010. Individual recommendations were classified based on their strength of recommendation (levels A through C) and quality of evidence (levels I through III). Guidelines not following this format were excluded from further analysis. Evolution of IDSA guidelines was assessed by comparing 5 recently updated guidelines with their earlier versions.

    Results  In the 41 analyzed guidelines, 4218 individual recommendations were found and tabulated. Fourteen percent of the recommendations were classified as level I, 31% as level II, and 55% as level III evidence. Among class A recommendations (good evidence for support), 23% were level I (≥1 randomized controlled trial) and 37% were based on expert opinion only (level III). Updated guidelines expanded the absolute number of individual recommendations substantially. However, few were due to a sizable increase in level I evidence; most additional recommendations had level II and III evidence.

    Conclusions  More than half of the current recommendations of the IDSA are based on level III evidence only. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.