Treatment
Strength of Recommendation and Quality of Evidence
Category/Grade
Definition
Recommendation
SR - Strong
Clear desirable or undesirable effects
WR - Weak
Desirable and undesirable effects closely balanced or uncertain
Quality of Evidence
H - High
Consistent evidence from well-performed RCTs or exceptionally strong evidence from
unbiased observational studies
M - Moderate
Evidence from RCTs with important limitations or moderately strong evidence from
unbiased observational studies
L - Low
Evidence for ≥ one critical outcome from observational studies, from RCTs with serious
flaws or from indirect evidence
VL - Very low
Evidence for ≥ one critical outcome from unsystematic clinical observations or very
indirect evidence
GRADE
Implication
Comment
SR-H
Applies to most patients in most
circumstances
Further research is unlikely to change estimate
SR-M
Further research may change estimate
SR-L
SR-VL
Estimate of effect for at least one critical
outcome is very uncertain
WR-H
The best action may differ depending on
circumstances or patients or societal values
Further research is unlikely to change estimate
WR-M
Alternative approaches likely to be
better for some patients under some
circumstances
Further research may change estimate
WR-L
Other alternatives may be equally
reasonable
WR-VL
Any estimate of effect, for at least one critical
outcome, is very uncertain
For the complete GRADE Strength of Recommendations and Quality of the Evidence Table, visit the
IDSA website: http://www.idsociety.org/Guidelines_Other/
While a substantial minority of diabetic patients with a foot infection have underlying bone disease, no antibiotics
are specifically approved by the US FDA for this indication. Thus, the antibiotic recommendations in this
pocketcard must exclude recommendations for osteomyelitis.
Source Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG, Deery HG, Embil
JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E. 2012 Infectious Diseases Society of America
clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis.
2012;54(12):e132-e173.
Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient
care. It is applicable to specialists, primary care, and providers at all levels. This Guideline should not be considered
exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment
concerning the propriety of any course of conduct must be made by the clinician after consideration of each individual
patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated
with the distributor of this clinical reference tool. Tables in this guideline provide a concise summary; they should be
used in the context of all of the evidence and recommendations made in the full guideline.
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