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Most Guidelines for Infectious Diseases Don't Come From Clinical Trial Findings
Date:1/11/2011

By Amanda Gardner
HealthDay Reporter

TUESDAY, Jan. 11 (HealthDay News) -- Most recommendations on how to treat common infectious diseases are grounded in expert opinions or case reports, and not evidence from clinical trials, new research indicates.

That's not necessarily a bad thing, according to a study appearing in the Jan. 10 issue of the Archives of Internal Medicine, but it may be a wake-up call for more attention to be paid to hard research on infectious disease.

"We were surprised to see that even though they represent a large body of data and a huge amount of work done by many others, that more than half of those individual recommendations are based on the lowest quality of evidence, which is either an expert opinion or a case report or case series," said study co-author Dr. Ole Vielemeyer, an assistant professor of medicine in the division of infectious diseases and HIV medicine at Drexel University College of Medicine in Philadelphia.

The problem, he and others say, is that younger doctors in particular may look at these recommendations as something akin to gospel.

"Sometimes doctors-in-training think if it's written in the guidelines, there must be strong evidence behind it," said Vielemeyer. "They equate the two things without looking at the evidence behind it."

"Guidelines are there to guide people. They're not there to make decisions," added Dr. Paola Lichtenberger, an assistant professor of clinical medicine in the division of infectious diseases at the University of Miami Miller School of Medicine. "They tell you what facts we know, what experts are doing and what's the evidence behind them."

Still, she said, "I do think that infectious diseases need more clinical trials. It's quite a new field."

These researchers took a close look at the underlying basis for 41 different clinical practice guidelines that were set between 1994 and May 2010 for the treatment of a nu
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