What's the basis for treating infections your way? Quality assessment of review articles on the treatment of urinary and respiratory tract infectionsin older people

OBJECTIVE: To assess the quality of readily available review articles on ur inary and respiratory tract infections in older people. METHODS: Data sources were articles identified by MEDLINE, search (1988-199 8), review of the bibliographies of identified publications, textbooks from the library of a geriatric university: hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older p eople that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, me thodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles. RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfie d our criteria of applicability. Specifically, dosage, route of administrat ion, and treatment duration were often not described. The overall methodolo gical quality was low (mean score 1.9 +/- 1.0 on a scale of 9). No review s pecified the methods used to identify, select, and validate included inform ation. Authors of the review articles quoted an important number of other r eview articles and only a small number of clinical trials. Less than one-qu arter of these clinical trials actually comprised primarily an older popula tion. CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodolog ical quality. Therefore, more systematic review articles regarding treatmen t of older patients, as well as evidence-based practice guidelines, are nee ded.