IDSA GUIDELINES Bundle

Diabetic Foot Infections Without Osteomyelitis

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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. IDSADFI05132c 106 Commerce Street, Suite 105 Lake Mary, FL 32746  TEL: 407.878.7606  •  FAX: 407.878.7611  For additional copies: info@GuidelineCentral.com Copyright © 2013 All rights reserved

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