Navigation Links
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 number of leading infectious diseases such as such as bacterial meningitis, infectious diarrhea, Lyme disease and community-acquired pneumonia.

The 41 guidelines contained 4,218 individual recommendations, which the authors assessed on both quality and strength.

Fourteen percent of these were determined to have "level I evidence," meaning they had at least one randomized clinical trial, the gold standard of science, to back them up; 31 percent had "level II" evidence, meaning evidence from one well-conducted study, even though it wasn't a randomized controlled trial.

But more than half of the recommendations (55 percent) had only level III evidence, meaning the recommendations were based on the opinions of individual experts or panels, or case descriptions.

Globetrotters will be happy to know that travel medicine guidelines on infectious disease tended to have the highest quality of evidence behind them.

And the authors also found that updated guidelines did tend to contain more references than their predecessors, indicating that more studies are being done.

Except for HIV/AIDS, it is notoriously difficult to conduct good trials on infectious diseases, the experts said. Either there aren't enough people that contract these illnesses, they're difficult to diagnose or trials would simply be unethical to conduct -- for example, whether hand washing might reduce the risk of hospital-acquired infections.

Although the current IDSA [Infectious Diseases Society of America] guidelines are "as good as the evidence out there in the literature," Vielemeyer said, patients might get better treatment if there was more evidence to back up certain practices.

For example, he said, "there's still overuse of antibiotics. Often it's too long a duration and all these medications have side effects," he said. "If we had good evidence that three days of antibiotics is enough rather than seven days, I think that would make a difference."

Attorneys, too, might take note of how guidelines are formulated, Lichtenberger said.

"Lawyers assume that the guidelines are the last word [but] the guidelines are used to guide . . . they cannot in a single case tell you what to do," she said. "That's why the physician comes into the act and says, 'Okay, for my patient the guidelines are appropriate or the guidelines definitely are not for [this patient].'"

More information

Find more on infectious diseases guidelines at the Infectious Diseases Society of America.

SOURCES: Paola Lichtenberger, M.D., assistant professor, clinical medicine, division of infectious diseases, University of Miami Miller School of Medicine; Ole Vielemeyer, M.D., assistant professor, medicine, division of infectious diseases and HIV medicine, Drexel University College of Medicine, Philadelphia; Jan. 10, 2011, Archives of Internal Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. New Diagnostic Guidelines for Mental Illnesses Proposed
2. Developing guidelines for better reporting of health research
3. NIH Stem Cell Guidelines Should Be Modified, UCSF Team Reports
4. Patients Do Better at Hospitals That Follow Stroke Guidelines
5. Evidence-based care and outcomes improve at Get With The Guidelines-Stroke hospitals
6. Elseviers new Custom Publication Guidelines set new Standards for Publishing Pharma-Sponsored Content
7. Landacorp Teams with Milliman Care Guidelines to Improve Care Management Capabilities for Health Plans
8. Access to Mammograms Drops After Guidelines Change
9. kajeet Publishes Free Guidelines for Teen and Tween Cell Phone Use
10. Reed Group and ACOEM Renew Partnership for Return-to-Work and Treatment Guidelines
11. Arizona Oncology Praises New Guidelines for Patient Care
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Most Guidelines for Infectious Diseases Don't Come From Clinical Trial Findings
(Date:2/24/2017)... ... , ... The Radiology Business Management Association will select the 2017 ... Building Better Radiology Marketing Programs conference, held this year from March 5 ... awards are given out in five categories. They are:, ,     Patient ...
(Date:2/23/2017)... ... 23, 2017 , ... On February 22, 2017 the U.S. ... to withdraw previous guidance issued by the Obama Administration requiring schools to treat ... 2016 by the Obama Administration came in response to a growing number of ...
(Date:2/23/2017)... (PRWEB) , ... February 23, 2017 , ... Los Angeles-based ... episodes of WE TV’s “Mama June: From Not to Hot,” which will begin airing ... “Mama” June Shannon, known to millions from the 2012 reality television series, “Here Comes ...
(Date:2/23/2017)... ... February 23, 2017 , ... Dr. David Mahon leads Siena Dental, ... Dr. Mahon was named a 2017 Top Patient Rated Henderson Dentist by ... directory that recognizes local physicians and dentists who have earned high ratings and superior ...
(Date:2/23/2017)... Lincoln, RI (PRWEB) , ... February 23, 2017 ... ... announced today a new partnership with the Rhode Island Consortium for Autism Research ... provide an opportunity for children with autism spectrum disorder (ASD) to see films ...
Breaking Medicine News(10 mins):
(Date:2/23/2017)... Calif. , Feb. 23, 2017 ... leading the discovery and development of innovative medicines targeting ... full year 2016 financial results on Thursday, March 2, ... host a conference call and webcast on March 2, ... quarter and full year 2016 financial results and provide ...
(Date:2/23/2017)... ... Research and Markets has announced the addition of the "Global ... report to their offering. The Global Antifungal Drugs Market ... next decade to reach approximately $12.8 billion by 2025. ... the given segments on global as well as regional levels presented in ...
(Date:2/23/2017)... Ga., Feb. 23, 2017  MiMedx Group, Inc. (NASDAQ: ... tissue and patent-protected processes to develop and market advanced ... Spine, Sports Medicine, Ophthalmic, and Dental sectors of healthcare, ... and full year ended December 31, 2016. ... Revenue is a 31% increase over full year 2015 ...
Breaking Medicine Technology: