![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases
treatment guidelines 2006.

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention, Workowski KA, Berman SM.
Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases
treatment guidelines 2006. MMWR Morb Mortal Wkly Rep 2006 Aug
4;55(RR-11):78. \[222 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention. Proctitis, proctocolitis, and enteritis. Sexually
transmitted diseases treatment guidelines. MMWR Recomm Rep 2002 May
10;51(RR-6):66-7.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory and/or
warning information has been released.

-   [September 11, 2007, Rocephin (ceftriaxone
    sodium)](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Rocephin):
    Roche informed healthcare professionals about revisions made to the
    prescribing information for Rocephin to clarify the potential risk
    associated with concomitant use of Rocephin with calcium or
    calcium-containing solutions or products.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Sexually transmitted gastrointestinal syndromes, including proctitis,
proctocolitis, and enteritis

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Gastroenterology\
Infectious Diseases\
Internal Medicine\
Obstetrics and Gynecology\
Preventive Medicine

#### INTENDED USERS

Health Care Providers\
Managed Care Organizations\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To update the Sexually Transmitted Diseases Treatment Guidelines
    2002 (*MMWR 2002;51\[No. RR-6\]*)

-   To assist physicians and other health-care providers in preventing
    and treating sexually transmitted diseases (STDs)

#### TARGET POPULATION

Patients with suspected or documented acute sexually transmitted
proctitis, proctocolitis, and enteritis

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis**

1.  Evaluation of signs and symptoms (e.g., diarrhea, abdominal cramps,
    inflammation of the colonic mucosa, pain, tenesmus, rectal
    discharge)

2.  Anoscopy

3.  Sigmoidoscopy

4.  Stool examination

5.  Presence of polymorphonuclear leukocytes on Gram-stained anorectal
    secretion smears

6.  Stool culture

**Treatment/Management**

1.  Ceftriaxone (or another agent effective against rectal and genital
    gonorrhea) plus doxycycline

2.  Follow-up care

3.  Management of sex partners

#### MAJOR OUTCOMES CONSIDERED

-   Microbiologic cure

-   Alleviation of signs and symptoms

-   Prevention of sequelae

-   Prevention of transmission

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Subjective Review

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Beginning in 2004, the Centers for Disease Control and Prevention (CDC)
personnel and professionals knowledgeable in the field of sexually
transmitted diseases (STDs) systematically reviewed evidence (including
published abstracts and peer-reviewed journal articles) concerning each
of the major STDs, focusing on information that had become available
since publication of the *Sexually Transmitted Diseases Treatment
Guidelines, 2002*. Background papers were written and tables of evidence
constructed summarizing the type of study (e.g., randomized controlled
trial or case series), study population and setting, treatments or other
interventions, outcome measures assessed, reported findings, and
weaknesses and biases in study design and analysis. A draft document was
developed on the basis of the reviews.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Consensus Development Conference)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

In April 2005, the Centers for Disease Control and Prevention (CDC)
staff members and invited consultants assembled in Atlanta, Georgia, for
a 3-day meeting to present the key questions regarding sexually
transmitted disease (STD) treatment that emerged from the evidence-based
reviews and the information available to answer those questions. When
relevant, the questions focused on four principal outcomes of STD
therapy for each individual disease: 1) microbiologic cure, 2)
alleviation of signs and symptoms, 3) prevention of sequelae, and 4)
prevention of transmission. Cost-effectiveness and other advantages
(e.g., single-dose formulations and directly observed therapy of
specific regimens) also were discussed. The consultants then assessed
whether the questions identified were relevant, ranked them in order of
priority, and attempted to arrive at answers using the available
evidence. In addition, the consultants evaluated the quality of evidence
supporting the answers on the basis of the number, type, and quality of
the studies.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Sexually transmitted gastrointestinal syndromes include proctitis,
proctocolitis, and enteritis. Evaluation for these syndromes should
include appropriate diagnostic procedures (e.g., anoscopy or
sigmoidoscopy, stool examination, and culture).

Proctitis is inflammation of the rectum (i.e., the distal 10-12 cm) that
might be associated with anorectal pain, tenesmus, or rectal discharge.
*Neisseria gonorrhoeae*, *Chlamydia trachomatis* (including
lymphogranuloma venereum \[LGV\] serovars), *Treponema pallidum*, and
herpes simplex virus (HSV) are the most common sexually transmitted
pathogens involved. In patients coinfected with human immunodeficiency
virus (HIV), herpes proctitis might be especially severe. Proctitis
occurs predominantly among persons who participate in receptive anal
intercourse.

Proctocolitis is associated with symptoms of proctitis and diarrhea or
abdominal cramps and inflammation of the colonic mucosa, extending to 12
cm above the anus. Fecal leukocytes might be detected on stool
examination, depending on the pathogen. Pathogenic organisms include
*Campylobacter sp*., *Shigella sp*., *Entamoeba histolytica*, and
rarely, LGV serovars of *C. trachomatis*. Cytomegalovirus (CMV) or other
opportunistic agents might be involved in immunosuppressed HIV-infected
patients. Proctocolitis can be acquired by the oral route or by
oral-anal contact, depending on the pathogen.

Enteritis usually results in diarrhea and abdominal cramping without
signs of proctitis or proctocolitis; it occurs among persons whose
sexual practices include oral-anal contact. In otherwise healthy
persons, *Giardia lamblia* is most frequently implicated. When outbreaks
of gastrointestinal illness occur among social or sexual networks of men
who have sex with men (MSM), clinicians should consider sexual
transmission as a mode of spread and provide counseling accordingly.
Among HIV-infected patients, gastrointestinal illness can be caused by
other infections that usually are not sexually transmitted, including
CMV, *Mycobacterium avium-intracellulare*, *Salmonella sp*.,
*Campylobacter sp*., *Shigella sp*., *Cryptosporidium*,
*Microsporidium*, and *Isospora*. Multiple stool examinations might be
necessary to detect *Giardia*, and special stool preparations are
required to diagnose cryptosporidiosis and microsporidiosis. In
addition, enteritis might be directly caused by HIV infection.

When laboratory diagnostic capabilities are available, treatment
decisions should be based on the specific diagnosis. Diagnostic and
treatment recommendations for all enteric infections are beyond the
scope of these guidelines.

**Treatment**

Acute proctitis of recent onset among persons who have recently
practiced receptive anal intercourse is usually sexually acquired. Such
patients should be examined by anoscopy and should be evaluated for
infection with HSV, *N. gonorrhoeae*, *C. trachomatis*, and *T.
pallidum*. If an anorectal exudate is detected on examination or if
polymorphonuclear leukocytes are detected on a Gram-stained smear of
anorectal secretions, the following therapy may be prescribed while
awaiting additional laboratory tests.

***Recommended Regimen***

-   **Ceftriaxone** 125 mg intramuscularly (IM) (or another agent
    effective against rectal and genital gonorrhea)

> ***PLUS***

-   **Doxycycline** 100 mg orally twice a day for 7 days

Patients with suspected or documented herpes proctitis should be managed
in the same manner as those with genital herpes (see the National
Guideline Clearinghouse summary of the Centers for Disease Control and
Prevention guideline [Diseases Characterized by Genital
Ulcers](http://www.guideline.gov/summary/summary.aspx?doc_id=9675&nbr=005184),
the section Genital HSV Infections). If painful perianal ulcers are
present or mucosal ulcers are detected on anoscopy, presumptive therapy
should include a regimen for treating genital herpes. In addition, LGV
proctitis and proctocolitis also should be considered. Appropriate
diagnostic testing for LGV should be conducted in accordance with state
or federal guidelines, and doxycycline therapy should be administered
100 mg orally twice daily for 3 weeks.

**Follow-Up**

Follow-up should be based on specific etiology and severity of clinical
symptoms. Reinfection might be difficult to distinguish from treatment
failure.

**Management of Sex Partners**

Partners of patients with sexually transmitted enteric infections should
be evaluated for any diseases diagnosed in the index patient.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

Throughout the 2006 guideline document, the evidence used as the basis
for specific recommendations is discussed briefly. More comprehensive,
annotated discussions of such evidence will appear in background papers
that will be published in a supplement issue of the journal *Clinical
Infectious Diseases*.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate diagnosis, management and treatment of patients who have
acute proctitis, proctocolitis, and enteritis

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   These recommendations were developed in consultation with public-
    and private-sector professionals knowledgeable in the treatment of
    patients with sexually transmitted diseases (STDs). The
    recommendations are applicable to various patient-care settings,
    including family planning clinics, private physicians\' offices,
    managed care organizations, and other primary-care facilities.

-   These recommendations are meant to serve as a source of clinical
    guidance: health-care providers should always consider the
    individual clinical circumstances of each person in the context of
    local disease prevalence. These guidelines focus on the treatment
    and counseling of individual patients and do not address other
    community services and interventions that are important in STD/human
    immunodeficiency virus (HIV) prevention.

-   Diagnostic and treatment recommendations for all enteric infections
    are beyond the scope of these guidelines.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention, Workowski KA, Berman SM.
Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases
treatment guidelines 2006. MMWR Morb Mortal Wkly Rep 2006 Aug
4;55(RR-11):78. \[222 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1993 (revised 2006 Aug 4)

#### GUIDELINE DEVELOPER(S)

Centers for Disease Control and Prevention - Federal Government Agency
\[U.S.\]

#### GUIDELINE DEVELOPER COMMENT

These guidelines for the treatment of persons who have sexually
transmitted diseases (STDs) were developed by CDC after consultation
with a group of professionals knowledgeable in the field of STDs who met
in Atlanta, Georgia, during April 19--21, 2005.

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Chairpersons*: David Atkins, MD, Agency for Healthcare Research and
Quality, Rockville, Maryland; Kimberly A. Workowski, MD, National Center
for HIV, STD, and TB Prevention, CDC, and Emory University, Atlanta, GA

*Presenters*: Heidi Bauer, MD, California Sexually Transmitted Disease
Control Branch, Oakland, California; Emily J. Erbelding, MD, Johns
Hopkins University School of Medicine, Baltimore, Maryland; William M.
Geisler, MD, Department of Medicine, University of Alabama, Birmingham,
Alabama; Margaret Hammerschlag, MD, State University of New York,
Downstate Medical Center, Brooklyn, New York; Peter Leone, MD,
University of North Carolina School of Medicine, Chapel Hill, North
Carolina; Jenne Marrazzo, MD, University of Washington, Harborview
Medical Center, Seattle, Washington; Kenneth Hugh Mayer, MD, Brown
University Medical School, Providence, Rhode Island; Pablo Sanchez, MD,
University of Texas Southwestern Medical Center, Dallas, Texas; Bradley
Stoner, MD, PhD, Washington University, St. Louis, Missouri; Anna Wald,
MD, University of Washington, Harborview Medical Center, Seattle,
Washington; George Wendel, MD, University of Texas Southwestern Medical
School, Dallas, Texas; Karen Wendel, MD, University of Oklahoma Health
Science Center, Oklahoma City, Oklahoma; Harold C. Wiesenfeld, MD,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

*Moderators*: Willard Cates, Jr., MD, Family Health International,
Durham, North Carolina; King K. Holmes, MD, PhD, University of
Washington, Harborview Medical Center, Seattle, Washington; David
Martin, MD, Louisiana State University Medical Center, New Orleans,
Louisiana

*Rapporteurs*: Hunter Handsfield, MD, National Center for HIV, STD, and
TB Prevention, CDC, Atlanta, Georgia, University of Washington, Seattle,
Washington; William McCormack, MD, State University of New York Health
Science Center, Brooklyn, New York; Anne Rompalo, MD, Johns Hopkins
School of Medicine, Baltimore, Maryland

*Consultants*: Michael Augenbraun, MD, State University of New York
Health Science Center, Brooklyn, New York; Gail Bolan, MD, California
Department of Health, Oakland, California; Carolyn Deal, PhD, National
Institute of Allergy and Infectious Diseases, National Institutes of
Health, Bethesda, Maryland; Kenneth H. Fife, MD, PhD, Indiana University
School of Medicine, Indianapolis, Indiana; J. Dennis Fortenberry, MD,
Indiana University School of Medicine, Indianapolis, Indiana; Edward
Hook, III, MD, Department of Medicine, University of Alabama,
Birmingham, Alabama; Franklyn Judson, MD, University of Colorado
Department of Medicine and Preventive Medicine, Denver, Colorado; Alice
A. Kraman, PharmD; Emory Healthcare, Atlanta, Georgia; Roberta B. Ness,
MD, University of Pittsburgh Department of Medicine, Pittsburgh,
Pennsylvania; Paul Nyirjesy, MD, Drexel University College of Medicine,
Philadelphia, Pennsylvania; Jeffrey Peipert, MD, Women and Infants
Hospital, Providence, Rhode Island; Jane R. Schwebke, MD, Department of
Medicine, University of Alabama, Birmingham, Alabama; Mary Ann Shafer,
MD, University of California, San Francisco Department of Medicine, San
Francisco, California; David Soper, MD, Medical University of South
Carolina, Charleston, South Carolina; Lawrence Stanberry, MD, PhD,
University of Texas Medical Branch, Galveston, Texas; Heather Watts, MD,
National Institute of Child Health and Development, National Institutes
of Health, Bethesda, Maryland; Jonathan M. Zenilman, MD, Johns Hopkins
Bayview Medical Center, Baltimore, Maryland

*Liaison Participants*: Joanne Armstrong, MD, Women\'s Health, Aetna,
Sugar Land, Texas; James R. Allen, MD, American Social Health
Association, Durham, North Carolina; Margaret J. Blythe, MD, American
Academy of Pediatrics, Indianapolis, Indiana; Sherry R. Crump, MD,
American College of Preventive Medicine, Atlanta, GA; Carolyn D. Deal,
PhD, National Institutes of Health, Bethesda, Maryland; Jordon
Dimitrakov, MD, PhD, American Urological Association, Boston,
Massachusetts; Mark FitzGerald, MD, British Association for Sexual
Health and HIV, Southampton, United Kingdom; Edward Harrison, National
Commission on Correctional Health Care, Chicago, Illinois; Edward W.
Hook, III, MD, Infectious Disease Society of America, Birmingham,
Alabama; Michel Janier, MD, PhD, International Union Against Sexually
Transmitted Infections Europe, Paris, France; Abe Macher, MD, HIV/AIDS
Bureau, Rockville, Maryland; Francis J. Ndowa, MD, World Health
Organization, Geneva, Switzerland; Jeffrey F. Peipert, MD, American
College of Obstetricians and Gynecologists, Providence, Rhode Island;
Kees A. Rietmeijer, MD, PhD, Denver Public Health Department, Denver,
Colorado; Richard Rothman, MD, American College of Emergency Physicians,
Baltimore, Maryland; David Soper, MD, Infectious Diseases Society for
Obstetrics and Gynecology, Charleston, South Carolina; Litjen Tan, PhD,
American Medical Association, Chicago, Illinois; Bruce Trigg, MD,
National Coalition for Sexually Transmitted Disease Directors,
Albuquerque, New Mexico; Julia Valderrama, MD, Pan American Health
Organization, Washington, DC; Tom Wong, MD, Public Health Agency of
Canada, Ottawa, Ontario, Canada; Miriam Zieman, MD, Association of
Reproductive Health Professionals, Atlanta, Georgia

*CDC, Division of Sexually Transmitted Disease Prevention Treatment
Guidelines 2006 Project. Coordinator*: Kimberly A. Workowski, MD,
National Center for HIV, STD, and TB Prevention, CDC, and Emory
University, Atlanta, GA

*Project Manager*: Donald F. Dowda, ORISE, Oakridge, Tennessee; Richard
Voigt, National Center for HIV, STD, and TB Prevention, CDC, Atlanta,
Georgia

*Co-Moderators*: Lyn Finelli, Ph.D., DSTDP; Robert Johnson, M.D., DSTDP;
Lauri Markowitz, M.D., DSTDP

*CDC Presenters*: Joanna Buffington, MD, National Center for Infectious
Diseases; Eileen Dunne, MD, National Center for HIV, STD, and TB
Prevention, CDC, Atlanta, Georgia; Matthew Hogben, PhD, National Center
for HIV, STD, and TB Prevention, CDC, Atlanta, Georgia; Emily Koumans,
MD, National Center for HIV, STD, and TB Prevention, CDC, Atlanta,
Georgia; Hershel Lawson, MD, National Center for Chronic Disease
Prevention and Health Promotion, Atlanta, Georgia; Catherine McLean, MD,
National Center for HIV, STD, and TB Prevention, Atlanta, Georgia;
Juliette Morgan, MD, National Center for Infectious Diseases, CDC,
Atlanta, Georgia; Lori Newman, MD, National Center for HIV, STD, and TB
Prevention, CDC, Atlanta, Georgia; Madeline Sutton, MD, National Center
for HIV, STD, and TB Prevention, CDC, Atlanta, Georgia

*CDC Consultants*: Sevgi O. Aral, PhD, Stuart M. Berman, MD, John
Douglas, MD, Susan J. DeLisle, Kathleen Ethier, PhD, National Center for
HIV, STD, and TB Prevention, CDC, Atlanta, Georgia; Kevin Fenton, MD,
National Center for HIV, Hepatitis, Sexually Transmitted Diseases and
Tuberculosis Prevention, CDC, Atlanta, Georgia; John Moran, MD, National
Immunization Program, CDC, Atlanta, Georgia; Julia Schillinger, MD,
National Center for HIV, STD, and TB Prevention, CDC, Atlanta, Georgia

*Support Staff*: Valerie Barner, Winda Graves, Garrett Mallory, Deborah
McElroy, National Center for HIV, STD, and TB Prevention, CDC, Atlanta,
Georgia; Eboney Walker, NAI Personnel, Washington, DC

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention. Proctitis, proctocolitis, and enteritis. Sexually
transmitted diseases treatment guidelines. MMWR Recomm Rep 2002 May
10;51(RR-6):66-7.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the Centers for Disease Control and
Prevention (CDC) Web site:

-   [HTML Format](http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm)

-   [Portable Document Format
    (PDF)](http://www.cdc.gov/mmwr/PDF/rr/rr5511.pdf)

Print copies: Available from the Centers for Disease Control and
Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased
from the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402-9325; (202) 783-3238.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Workowski KA, Levine WC, Wasserheit JN. U.S. Centers for Disease
    Control and Prevention guidelines for the treatment of sexually
    transmitted diseases: an opportunity to unify clinical and public
    health practice. Ann Intern Med. 2002 Aug 20;137(4):255-62.
    Electronic copies: Available through [Annals of Internal Medicine
    Online](http://www.annals.org/issues/v137n4/full/200208200-00010.html).

-   The CDC Sexually Transmitted Diseases Treatment Guidelines 2004 for
    PDA or Palm OS. Available from the [CDC National Prevention
    Information Network (NPIN) Web
    site](http://www.cdcnpin.org/scripts/std/pda.asp).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on September 5, 2002. This NGC
summary was updated by ECRI on October 18, 2006. This summary was
updated by ECRI Institute on October 3, 2007 following the U.S. Food and
Drug Administration (FDA) advisory on Rocephin (ceftriaxone sodium).

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008