We pride ourselves in practicing evidence based medicine but who are we kidding?
Yesterday I met with colleagues from trauma and orthopedic surgery. The purpose was to develop standardized pre and post-operative antibiotic protocols for open (compound) fractures. Sounds simple, however, the current body of evidence on the duration of antibiotic use for open fractures is not backed by robust evidence.
But wait, don’t knock the surgeons. Physicians are plagued by similar lack of robust data. I refer you to this article, published in Clinical Infectious Diseases, on The Quality and Strength of Evidence of the Infectious Diseases Society of America Clinical Practice
Guidelines (Clinical practice guidelines are frequently adopted as the ‘standard of care’).
The conclusion: The IDSA guideline recommendations are primarily based on low-quality evidence derived from non-randomized studies or expert opinion.
Medical practice, even the standard of care, may not be backed by strong, clinical data.
