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Back To Vidyya The Practice Guideline Clearing House

Many Organizations Working Together


The National Guidelines Clearinghouse (NGC) is an Internet Web site intended to make evidence-based clinical practice guidelines widely available to health care professionals. The NGC is the creation of the U.S. Dept. of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) in partnership with the American Medical Association (AMA), and the American Association of Health Plans (AAHP).

The goals of the NGC are:

  • To support research designed to improve the quality of health care, reduce its cost, and broaden access to essential services.
  • To develop and disseminate evidence-based information to increase the scientific knowledge needed to enhance patient and clinical decision-making, improve health care quality, and promote efficiency in the organization of public and private systems of health care delivery.

Unlike much of the government's information, the guidelines and materials appearing on the National Guideline Clearinghouse Web site are the products of named organizations and many of them can not be reprinted and distributed freely.

Practitioners will find helpful, objective summaries for each guideline on the site. These summaries are prepared by AHRQ's contractor, ECRI, in consultation with the responsible organizations that prepared the respective guidelines. The authors and publishers of every document at this site are identified at the beginning of each document. Though written by the government, the summaries are protected by copyright law.

The guidelines are intended for a broad audience that includes:

  • Physicians, nurses, and other health care professionals and provider organizations
  • Health plans, health systems, health care organizations, hospitals, and integrated health care delivery systems
  • Medical specialty and professional societies
  • Researchers
  • Federal, State, and local government health care policymakers and specialists
  • Employee benefit managers.

Nearly any medical professional can find a guideline in this collection that he will find to be of use. The cooperation that has gone into creating the site which includes heavily copyrighted materials from a variety of publications and organizations is phenomenal. Anyone with an interest in evidence-based medicine or industry "best practices" should bookmark this site. It is an important one.

Below is an example of a "Brief Summary" of a guideline from the CDC. The guideline summary appears in it's entirety and has been downloaded directly from the NGC Web site. There are hundreds of guidelines on the site. This guideline was chosen because it covers a common health problem, otitis media. This particular guideline is free from copyright restrictions. For more information, visit the National Guideline Clearinghouse.


Brief Summary

TITLE:
Acute otitis media: management and surveillance in an era of pneumococcal resistance.

SOURCE(S):
Pediatr Infect Dis J 1999 Jan;18(1):1-9 [33 references]

ADAPTATION:
Not applicable: Guideline was not adapted from another source.

RELEASE DATE:
1999

MAJOR RECOMMENDATIONS:
In response to the rapid dissemination of drug-resistant Streptococcus pneumoniae (DRSP) and the evidence that such dissemination may have a substantial impact on the management of otitis media, the DRSP therapeutic working group makes the following recommendations:

  • Amoxicillin should be the first-line antibiotic for acute otitis media.
  • In view of the increasing prevalence of DRSP, the safety of amoxicillin at higher than standard dosages, and evidence that higher dosages of amoxicillin can achieve effective middle ear fluid concentrations; the initial dose of amoxicillin should be increased from 40 to 45 mg/kg/day to 80 to 90 mg/kg/day.
  • Patients at very low risk for infection with DRSP (e.g., patients older than 2 years with no antimicrobial exposure in the preceding 3 months and no day-care attendance) would be appropriate candidates for amoxicillin given in the standard dosage of 40 to 45 mg/kg/day.
  • In cases of clinically defined treatment failure, consideration should be given to identification of the etiologic agent by tympanocentesis for susceptibility testing to guide alternate antibiotic therapy.
  • For clinically defined treatment failures after 3 days of therapy, an alternative agent should be selected after considering the likelihood of infection with resistant strains and should be effective with against DRSP and beta-lactamase-producing pathogens. Three agents that best meet these criteria include oral amoxicillin-clavulanate, oral cefuroxime axetil, and intramuscular ceftriaxone. Many of the 13 other Food and Drug Administration-approved otitis media drugs lack good evidence for efficacy against DRSP.
  • Currently available data on local patterns of pneumococcal resistance from microbiology laboratories, health departments, or published surveys are often poorly representative of the outpatient population with AOM. In general such data should rarely be used to guide treatment decisions for AOM.
  • Recommendations to improve surveillance include establishing criteria for setting susceptibility breakpoints for clinically appropriate antimicrobials to ensure relevance for treating AOM, testing middle ear fluid or nasal swab isolates in addition to sterile site isolates and testing of drugs that are useful in treating AOM.
  • Future electronic laboratory surveillance may be both comprehensive and timely. Such surveillance may eventually allow clinicians to incorporate local susceptibility information into clinical decision making.

CLINICAL ALGORITHM(S):
None provided

DEVELOPER(S):
Centers for Disease Control and Prevention (CDC) - Federal Government Agency [U.S.]

COMMITTEE:
Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group

GROUP COMPOSITION:
The Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group was convened by the Centers for Disease Control and Prevention (CDC) to respond to changes in antimicrobial susceptibility and included among its members practicing pediatricians, family physicians and internists, academicians, and public health practitioners

Authors: Scott F. Dowell, MD, MPH; Jay C. Butler, MD; G. Scott Giebink, MD; Michael R. Jacobs, MD; Daniel Jernigan, MD; Daniel M. Musher, MD; Alexander Rakowsky, MD; Benjamin Schwartz, MD, and the Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group.

ENDORSER(S):
Not stated

GUIDELINE STATUS:
This is the current release of the guideline.

An update is not in progress at this time.

GUIDELINE AVAILABILITY:
Electronic Copies: Not available at this time.

Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

COMPANION DOCUMENTS:
None available

PATIENT RESOURCES:
Not stated

NGC STATUS:
This summary was completed by ECRI on March 20, 1999. The information was verified by the guideline developer on April 30, 1999.

COPYRIGHT STATEMENT:
No copyright restrictions apply.

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