Introduction
Methods
Design
Data sources and searches
Eligibility criteria
Guideline selection process
Data extraction process
Box 1: characteristics and outcomes for which data were extracted
Assessment of the quality of guidelines
Data synthesis and analysis
Modifications from the protocol
Results
Characteristics of included guidelines
Characteristic or classification | n (%) |
---|---|
Year of publication | |
2011–2013 | 15 (18.3) |
2014–2016 | 21 (25.6) |
2017–2019 | 35 (42.7) |
2020-present | 11 (13.4) |
Continent of origin | |
Europe | 41 (50.0) |
North America | 19 (23.2) |
Asia | 12 (14.6) |
Australia | 3 (3.7) |
South America | 2 (2.4) |
Other* | 5 (6.1) |
Language of publication | |
English | 57 (69.5) |
Dutch | 7 (8.5) |
Finnish | 5 (6.1) |
German | 4 (4.9) |
Other** | 9 (11.0) |
Body system addressed by guideline | |
Respiratory*** | 50 (61.0) |
Urinary | 20 (24.4) |
Skin and soft tissue (SSTI) | 12 (14.6) |
AGREE II domain scores across all guidelines | |
---|---|
Domain score | Median score (range%) |
Scope and purpose | 86.1 (38.9–100) |
Clarity of presentation | 84.8 (50.0–100) |
Rigour and development | 79.2 (11.5–100) |
Stakeholder involvement | 77.8 (16.7–100) |
Editorial independence | 70.8. (4.2–100) |
Applicability | 64.5 (20.8–91.7) |
The inclusion of natural history information for acute infections in the guidelines
Respiratory (n = 68) | Urinary (n = 26) | SSTI (n = 20) | Total (n = 114) | |
---|---|---|---|---|
Natural history information reported | ||||
Yes, n (%) | 53 (78.0) | 10 (38.5) | 3 (15.0) | 66 (57.9) |
*Supporting reference for the information provided | ||||
Yes, n (%) | 49 (92.5) | 9 (90) | 2 (66.7) | 60 (91) |
The reporting of natural history information
System | Extended level* | Basic level** |
---|---|---|
Respiratory | Examples Acute Bronchitis | |
AUS 03: Acute bronchitis is a self-limiting lower respiratory tract infection. Explain that the cough lasts on average for 2 to 3 weeks and 90% of patients have cough resolution by four weeks. Occasionally, the cough may persist for up to 8 weeks | DEN02: In uncomplicated acute bronchitis in otherwise healthy individuals, no marginal effect of antibiotic treatment measured on the duration or symptom reduction | |
Acute sinusitis | ||
NICE07: Acute sinusitis is usually caused by a virus, lasts for about 2–3 weeks, and most people get better without antibiotics. Acute sinusitis usually follows a common cold, and symptoms for around 10 days or less are more likely to be associated with a cold rather than viral or bacterial acute sinusitis. Therefore, the committee agreed that an antibiotic prescription should not be offered to people presenting with acute sinusitis symptoms for around 10 days or less | FIN03: The majority of patients with sinusitis recover without antimicrobial therapy. Antimicrobial therapy should not be used to treat mild sinusitis because the disadvantages of treatment are more likely than its benefits | |
Urinary | Lower urinary tract infection | |
SCT03: Lower UTI is a self-limiting disease. If untreated, increased daytime urinary frequency lasts on average 6.3 days, dysuria 5.2 days, urgency 4.7 days, and patients report feeling generally unwell for on average 5.3 days, with moderately bad or worse symptoms for 3.8 days | NICE08: In most cases, managing lower UTIs will require antibiotic treatment. However, acute, uncomplicated lower UTI in non-pregnant women can be self-limiting and for some women delaying antibiotic treatment with a backup prescription to see if symptoms will resolve without antibiotic treatment may be an option | |
SSTI | Impetigo | |
COL01: Impetigo is in principle self-resolving, in a case where the infection is mild and there are no comorbidities in the patients, it may not require specific treatment |