Do Cochrane reviews influence guidelines for common acute respiratory infections?

Article type
Authors
Bhasale A
Abstract
Background: The extent to which Cochrane reviews are used in guidelines is one measure of how much they inform clinical practice. The level of use of Cochrane reviews in guidelines for antibiotic prescribing in common acute respiratory infections is largely unknown.

Objectives: To determine the extent to which Cochrane reviews are used in prescribing guidelines for common acute respiratory infections (ARIs). To identify the extent to which the recommendations of Cochrane reviews match guideline recommendations.

Methods:

Guidelines published in English that provide recommendations about the use of antibiotics in common acute respiratory infections are being identified and reviewed.

For each guideline recommendation about the use of antibiotics in common acute respiratory infections, the following questions are assessed:

- Is there a relevant Cochrane review?

- Is the Cochrane review specifically relevant to the guideline recommendation?

- Does the Cochrane review make an explicit recommendation or present evidence on the guideline recommendation?

- What proportion of recommendations within guidelines cite a Cochrane review?

- When a Cochrane review is available and relevant, which sources are used by preference?

- Does inclusion of the review differ according to the direction and strength of the Cochrane review findings?

- Using results from a clinical audit of Australian general practitioners (GPs), the degree of consistency between GP-reported prescribing and Australian antibiotic prescribing guidelines will be assessed.


Results and conclusions: Our results show the extent to which Cochrane reviews are used in evidence-based guidelines for use of antibiotics in ARIs, and how congruent guidelines are with review recommendations and findings. It is not possible to identify why Cochrane reviews are not used in guidelines. Nonetheless, the results could indicate to the Cochrane Acute Respiratory Infections Group where new reviews are required, and the practical implications of existing reviews for practice guidelines. The Australian National Prescribing Service clinical audit data provide an indication of how well guidelines are reflected in clinical practice.