Today, I'm going to write about something that came up on my infectious diseases rotation this month.

The Infectious Diseases Society of America (IDSA) just published new guidelines for treating intra-abdominal infections. They came out at the beginning January. Apparently, there's been some debate in the ID world over whether these guidelines have too much industry influence. Several of the authors of the guidelines have connections with drug companies, and several of those drug companies happen to have recently come out with some very broad-spectrum, very expensive new antibiotics. These new antibiotics are part of the guidelines, and they are listed as options to treat intra-abdominal infections while some older, generic antibiotics were excluded because of concerns about resistance.

So there is debate and controversy over these new guidelines. The issue becomes a bit more complicated when you look at it from the hospital's perspective. We try to practice evidence-based medicine, as much as possible, and guidelines from major organizations like the IDSA are important tools in doing that, since they are essentially literature reviews. At a hospital like UM, the hospital's guidelines and policies might be based on the IDSA guidelines.

The question then becomes, if you are responsible for creating your hospital's antibiotic policies, what do you do with these guidelines? If you think there's too much industry bias, do you still base hospital policy on them? Do you ignore them? Do you just take the parts you think are unbiased and ignore the rest? And if you have to go through and figure out which parts are biased and which are not, how is that different than creating your own guidelines and ignoring the IDSA ones?

And if you have a patient with an intra-abdominal infection, and they die, and the patient's family thinks you should have used one of these newer, broad-spectrum antibiotics, then what? The patient's family/lawyers can point to the guidelines and say, look, here are national guidelines that say you could have used this drug. Why didn't you? Then you are left defending the tenuous position that national guidelines don't constitute standard of care.

And yet, if you really think that using the newer antibiotics will unnecessarily increase resistance and cost, you are ethically (and financially) obligated to restrict them.

It's a balance that each hospital has to find on its own. I think a big part of the answer is to look at resistance levels at your hospital, and to decide whether the older antibiotics will work in most cases or not. Cost, as always, is important as well.

In the end, guidelines are just that - guidelines. They shouldn't dictate policy on their own; there should be a significant amount of thought put into the value of the guidelines and of policy changes at a given hospital. That's why there are infectious disease specialty physicians and pharmacists.