Can We Have Guidelines or Just Guidance for Rare Fungal Infections?

In this perspective, we discuss the limitations of medical guidelines as it relates to the management of uncommon invasive fungal infections (IFIs) or infrequent manifestations of more common IFIs. We emphasize the difficulties to define "gold standards" for diagnostics and treatment based on limited and low-quality evidence. We posit that such "guidelines" based on scarce data may be suboptimal and could be in some cases even harmful. Specifically, guidelines are often seen as rigid rules to follow which can prevent a critical examination of the nuanced management of individual patients with rare IFIs. We also emphasize that guidelines are often not updated frequently enough and therefore may not reflect the current treatment landscape. For all those reasons, we suggest that the term "guidance" may be more appropriate than "guidelines" for rare IFIs. Finally, we pose several questions regarding constructing future "Guidelines"/"Guidance for such entities".