Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE.docVIP

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Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE.doc

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Agweyuetal.BMCPediatrics2012,12:1 /1471-2431/12/1 CORRESPONDENCE OpenAccess Experiencedevelopingnationalevidence-based clinicalguidelinesforchildhoodpneumoniaina low-incomesetting-makingtheGRADE? AmbroseAgweyu1*?,NewtonOpiyo1?andMikeEnglish1,2? Abstract Background:Thedevelopmentofevidence-basedclinicalpracticeguidelineshasgainedwideacceptanceinhigh- incomecountriesandreputableinternationalorganizations.Whereasthisapproachmaybeadesirablestandard, challengesremaininlow-incomesettingswithlimitedcapacityandresourcesforevidencesynthesisandguideline development.WepresentourexperienceusingtheGradingofRecommendationsAssessment,Developmentand Evaluation(GRADE)approachfortherecentrevisionoftheKenyanpediatricclinicalguidelinesfocusingon antibiotictreatmentofpneumonia. Methods:Ateamofhealthprofessionals,manywithminimalpriorexperienceconductingsystematicreviews, carriedoutevidencesynthesisforstructuredclinicalquestions.Summarieswerecompiledanddistributedtoa panelofclinicians,academiciansandpolicy-makerstogeneraterecommendationsbasedonbestavailableresearch evidenceandlocally-relevantcontextualfactors. Results:Wereviewedsixeligiblearticlesonnon-severeand13onsevere/veryseverepneumonia.Moderate qualityevidencesuggestingsimilarclinicaloutcomescomparingamoxicillinandcotrimoxazolefornon-severe pneumoniareceivedastrongrecommendationagainstadoptingamoxicillin.Thepanelvotedstronglyagainst amoxicillinforseverepneumoniaoverbenzylpenicillindespitemoderatequalityevidencesuggestingclinical equivalencebetweenthetwoandadditionalfactorsfavoringamoxicillin.Verylowqualityevidencesuggesting ceftriaxonewasaseffectiveasthestandardbenzylpenicillinplusgentamicinforveryseverepneumoniareceiveda strongrecommendationsupportingthestandardtreatment. Conclusions:Althoughthisexercisemayhavefallenshortoftherigorousrequirementsrecommendedbythe developersofGRADE,itwasarguablyanimprovementonpreviousattemptsatguidelinedevelopmentinlow- incomecountriesandoffersvaluablelessonsforfuturesimilarexerciseswhereresourcesa