Category | Number of recommendations* | Guideline: Choosing Wisely recommendation | Justification (level of evidence) |
---|---|---|---|
Unfavorable balance between benefits and harms | 27 | Urinary tract infection: Do not treat asymptomatic bacteriuria in the elderly, because it does not decrease incontinence, urinary tract infections or mortality. | Eradication of bacteriuria does not decrease incontinence, urinary tract infections or mortality. Antibiotics have side effects and increase antimicrobial resistance. (A) |
Ineffective treatment or insensitive diagnostic test | 22 | Tendon disorders of the shoulder: Do not use ultrasound to treat tendon disorders of the shoulder. | Ultrasound therapy is not more effective than placebo (pain, function). (A) |
Unnecessary intervention | 11 | Stable Coronary Artery Disease: Do not do an exercise test for a patient with chest pain and low probability of coronary artery disease. | In this patient group the likelihood of a false positive result is high. (no evidence summary) [22, 23] |
Alternative treatment options more effective | 8 | Acute otitis media: Do not routinely treat tympanostomy tube otorrhea with oral antibiotics. | Topical antibiotics are more effective than oral antibiotics in the treatment of tympanostomy tube otorrhea. Oral antibiotics have more side effects and increase antimicrobial resistance. (B) |
Unfavorable balance between benefits and costs | 3 | Age-related macular degeneration: Avoid ranibizumab and aflibercept as first line treatments for age related macular degeneration due to high costs. | Comparable effectiveness but higher costs than other treatment options. (B) |
No evidence for effectiveness | 2 | Glaucoma: Do not routinely measure diurnal fluctuations in intraocular pressure following monitoring progression of glaucoma. | The benefit is uncertain. There is little research and its quality is low. (D) |