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. 2022 Dec 29;10(1):ofac706.
doi: 10.1093/ofid/ofac706. eCollection 2023 Jan.

Can the Future of ID Escape the Inertial Dogma of Its Past? The Exemplars of Shorter Is Better and Oral Is the New IV

Kusha Davar  1 , Devin Clark  1 , Robert M Centor  2 , Fernando Dominguez  1 , Bassam Ghanem  3 , Rachael Lee  4 , Todd C Lee  5 , Emily G McDonald  6 , Matthew C Phillips  7   8 , Parham Sendi  9 , Brad Spellberg  1
Affiliations

Can the Future of ID Escape the Inertial Dogma of Its Past? The Exemplars of Shorter Is Better and Oral Is the New IV

Kusha Davar et al. Open Forum Infect Dis. .

Abstract

Like all fields of medicine, Infectious Diseases is rife with dogma that underpins much clinical practice. In this study, we discuss 2 specific examples of historical practice that have been overturned recently by numerous prospective studies: traditional durations of antimicrobial therapy and the necessity of intravenous (IV)-only therapy for specific infectious syndromes. These dogmas are based on uncontrolled case series from >50 years ago, amplified by the opinions of eminent experts. In contrast, more than 120 modern, randomized controlled trials have established that shorter durations of therapy are equally effective for many infections. Furthermore, 21 concordant randomized controlled trials have demonstrated that oral antibiotic therapy is at least as effective as IV-only therapy for osteomyelitis, bacteremia, and endocarditis. Nevertheless, practitioners in many clinical settings remain refractory to adopting these changes. It is time for Infectious Diseases to move beyond its history of eminent opinion-based medicine and truly into the era of evidenced-based medicine.

Keywords: antibiotic; dogma; evidenced-based medicine; oral antibiotics; shorter is better.

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References

    1. Spellberg B, Shorr AF. Opinion-based recommendations: beware the tyranny of experts. Open Forum Infect Dis 2021; 8:ofab490. - PMC - PubMed
    1. Spellberg B, Wright WF, Shaneyfelt TM, Centor RM. The future of medical guidelines—standardizing clinical care with the humility of uncertainty. Ann Intern Med 2021; 174:1740–42. - PubMed
    1. Spellberg B. Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them. New York: Prometheus Press, 2009.
    1. Swainson B. Encarta Book of Quotations. Bellevue, Washington: Encarta, 2000.
    1. Northey EH. The Sulfonamides and Allied Compounds. New York: Reinhold Publishing, Inc., 1948.