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IDSA Practice Guidelines

Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. [Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990]

Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process, review of evidence, and documentation. [Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990]

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Latest Guidelines

The Practice of Travel Medicine

Status: Retired

Travel medicine is devoted to the health of travelers who visit foreign countries. It is an interdisciplinary specialty concerned not only with prevention of infectious diseases during travel but also

Travel medicine is devoted to the health of travelers who visit foreign countries. It is an interdisciplinary specialty concerned not only with prevention of infectious diseases during travel but also with the personal safety of travelers and the avoidance of environmental risks.Full text *Information contained in the following guideline is outdated or superseded by another publication and should be used for historical purposes only. For other information related to travel medicine visit the following:CDC Travel HealthCDC YellowbookISTM Global Travel Clinic Directory

Lyme Disease

Status: Update in Progress

Lyme disease is the most common tick-borne infection in both North America and Europe. In the United States, Lyme disease is caused by Borrelia burgdorferi, which is transmitted by the

Lyme disease is the most common tick-borne infection in both North America and Europe. In the United States, Lyme disease is caused by Borrelia burgdorferi, which is transmitted by the bite of the tick species Ixodes scapularis and Ixodes pacificus. Clinical manifestations most often involve the skin, joints, nervous system, and heart. Full textApproximately every 12 – 18 months following publication, IDSA evaluates its guidelines for the need for update.  Because several years have passed since the last update, IDSA determined that a new undertaking for Lyme disease guidelines was needed. In order to develop a more focused and manageable guideline than the previous guideline which had a very broad scope, the IDSA has decided to approach this guideline topic differently by separating the topic into distinct guidelines.  This is a practice that IDSA has implemented across many of its guidelines where the scope has been expansive. The first of these guideline topics to be addressed will be on the prevention, diagnosis, and treatment of Lyme disease.  This guideline is being developed jointly with the American Academy of Neurology and the American College of Rheumatology.  Other collaborators on the guideline include panel members from the following: American Academy of Family Physicians (AAFP), American Academy of Pediatrics – Committee on Infectious Diseases (AAP-COID), American Academy of Pediatrics – Section on Emergency Medicine (AAP-EM), American College of Physicians (ACP), Association of Medical Microbiology and Infectious Diseases – Canada (AMMI-CA), Child Neurology Society (CNS), Pediatric Infectious Diseases Society (PIDS), Entomological Society of America (ESA), European Society of Clinical Microbiology and Infectious Diseases (ESCMID).  Individuals from the disciplines of cardiology, microbiology and pathology as well as a consumer representative and a methodologist with expertise in GRADE are also among the members of the guideline development panel. In contrast to the 2006 IDSA guidelines, this guideline will not provide comprehensive coverage of Anaplasma phagocytophilum and Babesia microti outside the context of co-infections. Those pathogens will be treated more comprehensively in separate, forthcoming clinical guidelines. Information on the status of these updates can be found here, within the Practice Guidelines/Infections by Organism/Bacteria section of the IDSA website. *Projected publication, Spring 2018

Asymptomatic Bacteriuria

Status: Update in Progress

The purpose of this guideline is to provide recommendations for diagnosis and treatment of asymptomatic bacteriuria in adult populations 18 years of age. The recommendations were developed on the basis

The purpose of this guideline is to provide recommendations for diagnosis and treatment of asymptomatic bacteriuria in adult populations 18 years of age. The recommendations were developed on the basis of a review of published evidence, with the strength of the recommendation and quality of the evidence graded using previously described Infectious Diseases Society of America (IDSA) criteria (table 1) [1]. Recommendations are relevant only for the treatment of asymptomatic bacteriuria and do not address prophylaxis for prevention of symptomatic or asymptomatic urinary infection. This guideline is not meant to replace clinical judgment.Screening of asymptomatic subjects for bacteriuria is appropriate if bacteriuria has adverse outcomes that can be prevented by antimicrobial therapy [2]. Outcomes of interest are short term, such as symptomatic urinary infection (including bacteremia with sepsis or worsening functional status), and longer term, such as progression to chronic kidney disease or hypertension, development of urinary tract cancer, or decreased duration of survival. Treatment of asymptomatic bacteriuria may itself be associated with undesirable outcomes, including subsequent antimicrobial resistance, adverse drug effects, and cost. If treatment of bacteriuria is not beneficial, screening of asymptomatic populations to identify bacteriuria is not indicated, unless performed in a research study to further explore the biology or clinical significance of bacteriuria. Thus, there are 2 topics of interest: whether asymptomatic bacteriuria is associated with adverse outcomes, and whether the interventions of screening and antimicrobial treatment improve these outcomes.Full textA correction has been published: Clin Infect Dis (2005) 40 (10): 1556. *Projected publication, Spring 2018

Control of Tuberculosis (TB)

Status: Current, Endorsed

During 1993–2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003)... In this statement, the American

During 1993–2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003)... In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. *For information on the timing of future updates to this guideline, contact the ATS.

Bacterial Meningitis

Status: Under Review

The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. Patients with bacterial meningitis are usually treated by primary care

The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons. In contrast to many other infectious diseases, the antimicrobial therapy for bacterial meningitis is not always based on randomized, prospective, double-blind clinical trials, but rather on data initially obtained from experimental animal models of infections. A model commonly utilized is the experimental rabbit model, in which animals are anesthetized and placed in a stereotactic frame. In this procedure, the cisterna magna can be punctured for frequent sampling of CSF and injection of microorganisms. Frequent sampling of CSF permits measurement of leukocytes and chemical parameters and quantitation of the relative penetration of antimicrobial agents into CSF and the effects of meningitis on this entry parameter, the relative bactericidal efficacy (defined as the rate of bacterial eradication) within purulent CSF, and CSF pharmacodynamics. Results obtained from these and other animal models have led to clinical trials of specific agents in patients with bacterial meningitis. Full text*The 2004 Practice Guidelines for the Management of Bacterial Meningitis has been split into two guidelines. The nosocomial guideline was published in 2017. For recommendations on community acquired, please see the original guideline in 2004.*This guideline is being either under reviewed to determine if it requires updating or is on the slate to be updated. Please use this version with discretion, as it possible that some information may be outdated.

Outpatient Parenteral Anti-Infective Therapy (OPAT)

Status: Update in Progress

These guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective

These guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective studies on the efficacy and safety of OPAT, few prospective studies have been conducted to compare the risks and outcomes for patients who receive treatment as outpatients rather than as inpatients. Because truly evidence-based studies are lacking, the present guidelines are formulated from the collective experience of the committee members and advisors from related organizations.  Full text*Projected Publication, Spring 2018

Management of Dyslipidemia in Adults Receiving ART

Status: Retired

Dyslipidemia is a common problem affecting HIV-infected patients receiving antiretroviral therapy. Since publication of preliminary guidelines in 2000, numerous studies have addressed the risk of cardiovascular disease, the mechanisms of

Dyslipidemia is a common problem affecting HIV-infected patients receiving antiretroviral therapy. Since publication of preliminary guidelines in 2000, numerous studies have addressed the risk of cardiovascular disease, the mechanisms of dyslipidemia, drug interactions, and the treatment of lipid disorders in HIV-infected patients. In addition, updated recommendations from the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) have been published that materially affect the clinical approach to lipid disorders in the general population.*Information contained in the following guideline is outdated or superseded by another publication and should be used for historical purposes only.

Diarrhea

Status: Update in Progress

The widening array of recognized enteric pathogens and the increasing demand for cost-containment sharpen the need for careful clinical and public health guidelines based on the best evidence currently available.

The widening array of recognized enteric pathogens and the increasing demand for cost-containment sharpen the need for careful clinical and public health guidelines based on the best evidence currently available. Adequate fluid and electrolyte replacement and maintenance are key to managing diarrheal illnesses. Thorough clinical and epidemiological evaluation must define the severity and type of illness (e.g., febrile, hemorrhagic, nosocomial, persistent, or inflammatory), exposures (e.g., travel, ingestion of raw or undercooked meat, seafood, or milk products, contacts who are ill, day care or institutional exposure, recent antibiotic use), and whether the patient is immunocompromised, in order to direct the performance of selective diagnostic cultures, toxin testing, parasite studies, and the administration of antimicrobial therapy (the latter as for traveler's diarrhea, shigellosis, and possibly Campylobacter jejuni enteritis). Increasing numbers of isolates resistant to antimicrobial agents and the risk of worsened illness (such as hemolytic uremic syndrome with Shiga toxin-producing Escherichia coli O157:H7) further complicate antimicrobial and antimotility drug use. Thus, prevention by avoidance of undercooked meat or seafood, avoidance of unpasteurized milk or soft cheese, and selected use of available typhoid vaccines for travelers to areas where typhoid is endemic are key to the control of infectious diarrhea.Full text*Projected Publication, Summer 2017

Fever and Infection in Long-term Care Facilities

Status: Current

Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever

Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided. Full Text*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 04/2013.

Pain Management for Patients with HIV

Status: New Guideline in Development

*Projected Publication, Summer 2017

*Projected Publication, Summer 2017

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