[Assessing the quality of evidence cited in French clinical practice guidelines for infectious diseases in primary...

To assess the level of evidence supporting antibiotic therapy recommendations in primary care.

After collecting the clinical practice guidelines (CPGs) listed on the Antibioclic® website (https://antibioclic.com), each recommendation regarding whether or not to prescribe antibiotics was evaluated based on whether it included a GRADE classification by the French National Authority for Health (HAS): A, B, C, or Expert Opinion (EO). The sources cited by the CPGs were reviewed. The recommendations and studies had to answer the question: "Should antibiotic therapy be prescribed in this situation?" The possible answers were "yes," "no," or "conditional yes," meaning delayed prescription. The primary outcome was the percentage of recommendations for which supporting studies were cited, in comparison to the stated GRADE.

A total of 152 recommendations from 49 CPGs on antibiotic prescription were analyzed. In all, 71.7% did not mention a level of evidence, 3.3% were classified as GRADE A, and 9.2% as GRADE B. Upon reviewing the studies used to justify the recommendations, high-quality evidence was identified for only 7.9% of the recommendations, while 80.9% had no referenced studies.

Most French recommendations regarding antibiotic prescription in primary care do not provide the level of evidence supporting them.