To create a new form of medical guideline that takes the strength of available evidence for a particular practice into account, we gathered 60 other physicians and pharmacists from eight countries on Twitter to draft the first WikiGuideline. Bone infections were voted as the conditions most in need of new guidelines.

We all voted on seven questions about bone infection diagnosis and management to include in the guideline, then broke into teams to generate answers. Each volunteer searched the medical literature and drafted answers to a clinical question based on the data. These answers were repeatedly revised in open dialogue with the group.

These efforts ultimately generated a document with more than 500 references and provided clarity to how providers currently manage bone infections. Of the seven questions we posed, only two had sufficient high-quality data to make a “clear recommendation” on how providers should treat bone infection. The remaining five questions were answered with reviews that provided pros and cons of various care options.

The recommendations WikiGuidelines arrived at differ from current bone infection guidelines by professional group for medical specialists. For example, WikiGuidelines makes a clear recommendation to use oral antibiotics for bone infections based on numerous randomized controlled trials. Current standard guidelines, however, recommend giving intravenous antibiotics, despite the evidence that giving treatment orally is not only just as effective as giving it intravenously, but is also safer and results in fewer side effects.

Providers benefit from careful review of a clinical case. When there isn’t enough data to make a clear recommendation, laying out what data is available can help inform their clinical judgment.

We believe that more inclusive guideline committees that open participation to qualified practitioners instead of just those within specialty societies could help make for better medical guidelines. The WikiGuidelines Group now has over 110 members from over 14 countries, many of which are lower- and lower-middle-income countries. We are currently working on a guideline for managing heart valve infections.

It is our hope that future guidelines can avoid the errors of the past by incorporating the humility of uncertainty into the process, acknowledging when the evidence is unclear and only issuing clear recommendations when high quality data can support them.

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Brad Spellberg, University of Southern California; Jaimo Ahn, University of Michigan, and Robert Centor, University of Alabama at Birmingham. Like this article? subscribe to our weekly newsletter.

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I have participated in multiple aspects of clinical practice guideline creation on multiple occasions.

Brad Spellberg and Robert Centor do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.