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Evidence Used for Clinical Guidelines May Be Weak

Most Infectious Diseases Society of America guidelines based on level III evidence

THURSDAY, Jan. 13 (HealthDay News) -- Most clinical practice guidelines put out by the Infectious Diseases Society of America (IDSA) are based on weaker, expert opinion-based evidence rather than more robust, randomized trial-based evidence, according to research published in the Jan. 10 issue of the Archives of Internal Medicine.

Dong Heun Lee, M.D., and Ole Vielemeyer, M.D., of the Drexel University College of Medicine in Philadelphia, analyzed the overall quality of evidence and strength of recommendations of 41 guidelines released between 1994 and 2010 by the IDSA.

The authors found that more than half of the recommendations, 55 percent, were classified as level III evidence, while 14 and 31 percent were classified as level I and level II, respectively. Among class A recommendations (good evidence for support), 37 percent were based only on expert opinion (level III), while 23 percent were level I (based on at least one randomized controlled trial). Later guidelines included substantially more individual recommendations, but based mostly on level II and III evidence.

"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," the authors write.

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