Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE?
Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE?
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DOI：
10.1186/1471-2431-12-1
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发表时间：
2012-01-01
期刊：
影响因子：
2.4
通讯作者：
English, Mike
中科院分区：
文献类型：
--
作者：
Agweyu, Ambrose;Opiyo, Newton;English, Mike
背景：基于证据的临床实践指南的发展在高收入国家和有信誉的国际组织中得到了广泛的接受。尽管这种方法可能是一种理想的标准，但在能力和资源有限的低收入环境中，证据合成和指南制定仍然存在挑战。我们介绍我们的经验，使用分级建议评估，发展和评估（GRADE）的方法最近修订肯尼亚儿科临床指南侧重于抗生素治疗肺炎。方法：一组卫生专业人员，其中许多人在进行系统评价方面经验很少，对结构化临床问题进行证据合成。汇编了摘要并分发给一个由临床医生、院士和决策者组成的小组，以便根据现有的最佳研究证据和当地相关的背景因素提出建议。结果：我们回顾了6篇关于非严重肺炎的合格文章和13篇关于严重/极严重肺炎的合格文章。中等质量的证据表明，比较阿莫西林和复方新诺明治疗非严重肺炎的临床结果相似，因此强烈建议不采用阿莫西林。尽管有中等质量的证据表明阿莫西林与苄青霉素在治疗重症肺炎方面具有临床等效性，而且其他因素也有利于阿莫西林，但专家组还是强烈反对阿莫西林优于苄青霉素。非常低质量的证据表明，头孢曲松与标准的青霉素加庆大霉素治疗非常严重的肺炎一样有效，因此强烈建议支持标准治疗。结论：虽然这项工作可能没有达到GRADE开发者推荐的严格要求，但它可以说是对低收入国家指南制定的先前尝试的改进，并为未来资源和当地产生的证据稀缺的类似工作提供了宝贵的经验教训。
Background: The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for the recent revision of the Kenyan pediatric clinical guidelines focusing on antibiotic treatment of pneumonia.Methods: A team of health professionals, many with minimal prior experience conducting systematic reviews, carried out evidence synthesis for structured clinical questions. Summaries were compiled and distributed to a panel of clinicians, academicians and policy-makers to generate recommendations based on best available research evidence and locally-relevant contextual factors.Results: We reviewed six eligible articles on non-severe and 13 on severe/very severe pneumonia. Moderate quality evidence suggesting similar clinical outcomes comparing amoxicillin and cotrimoxazole for non-severe pneumonia received a strong recommendation against adopting amoxicillin. The panel voted strongly against amoxicillin for severe pneumonia over benzyl penicillin despite moderate quality evidence suggesting clinical equivalence between the two and additional factors favoring amoxicillin. Very low quality evidence suggesting ceftriaxone was as effective as the standard benzyl penicillin plus gentamicin for very severe pneumonia received a strong recommendation supporting the standard treatment.Conclusions: Although this exercise may have fallen short of the rigorous requirements recommended by the developers of GRADE, it was arguably an improvement on previous attempts at guideline development in low-income countries and offers valuable lessons for future similar exercises where resources and locally-generated evidence are scarce.