From the Guidelines
The Infectious Diseases Society of America (IDSA) guidelines provide evidence-based recommendations for diagnosing and treating various infectious diseases, with a focus on antimicrobial stewardship and minimizing resistance development. The IDSA guidelines cover a wide range of conditions, including pneumonia, urinary tract infections, skin and soft tissue infections, endocarditis, meningitis, HIV, and many others 1. These guidelines are regularly updated based on new research and clinical evidence, and they typically recommend first-line antimicrobial agents, alternative options for patients with allergies or in cases of resistance, appropriate dosing regimens, and treatment durations.
Some key aspects of the IDSA guidelines include:
- Diagnostic testing and assessment of severity
- Guidance on when to consider hospitalization versus outpatient management
- Special considerations for specific patient populations, such as immunocompromised individuals, pregnant women, children, and the elderly
- Antimicrobial stewardship principles to minimize resistance development, as outlined in the 2016 guidelines for implementing an antibiotic stewardship program 1.
Healthcare providers should consult the most current version of the relevant IDSA guideline when managing specific infectious diseases, as recommendations evolve with emerging evidence and changing resistance patterns. The IDSA guidelines are developed using a systematic weighting of the strength of recommendation and quality of evidence, such as the GRADE system, to ensure that the recommendations are based on the best available evidence 1.
In terms of specific guidance, the IDSA guidelines provide recommendations for various infectious diseases, including candidiasis, as outlined in the 2004 guidelines for treatment of candidiasis 1. However, the most recent and highest quality study should be prioritized, and in this case, the 2016 guidelines for implementing an antibiotic stewardship program provide more general and up-to-date guidance on antimicrobial stewardship and minimizing resistance development 1.
From the Research
IDSA Guidelines Summary
- The Infectious Diseases Society of America (IDSA) guidelines are developed to assist in patient care and provide evidence-based recommendations for the treatment of infectious diseases 2, 3, 4.
- The guidelines are based on a ranking system for the strength of recommendation and the quality of evidence cited in the literature reviewed, with levels A through C signifying the strength of recommendation and levels I through III indicating the quality of evidence 3, 4.
- Approximately half of the recommendations in the current guidelines are supported by level III evidence (derived from expert opinion), while evidence from observational studies (level II) supports around 31% of recommendations, and evidence based on ≥ 1 randomized clinical trial (level I) constitutes around 16% of the recommendations 2, 4.
Specific Guidelines
- The IDSA has issued guidelines for the treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women, which include recommendations for antimicrobial therapy and provide a standard ranking system for the strength of the recommendation and the quality of the evidence cited in the literature reviewed 3.
- The IDSA has also issued guidelines for the treatment and management of patients with COVID-19, which include evidence-based rapid guidelines intended to support patients, clinicians, and other health-care professionals in their decisions about treatment and management of patients with COVID-19 5.
- Additionally, the IDSA has issued guidance on the treatment of antimicrobial-resistant gram-negative infections, which includes preferred and alternative suggested treatment approaches with accompanying rationales, assuming the causative organism has been identified and antibiotic susceptibility results are known 6.
Limitations and Future Directions
- The IDSA guideline recommendations are primarily based on low-quality evidence derived from nonrandomized studies or expert opinion, highlighting the limitations of current clinical infectious diseases research that can provide high-quality evidence 2, 4.
- There is an urgent need to support high-quality research to strengthen the evidence available for the formulation of guidelines, and the IDSA guideline panel has expressed the overarching goal that patients be recruited into ongoing trials to provide much-needed evidence on the efficacy and safety of various therapies for infectious diseases 2, 5.