Background: Clinical practice guideline (CPG) development is a useful strategy for healthcare quality improvement, although is logistically and financially demanding. There are important differences in resources between developed and developing countries. Some researchers have advocated the use of adaptation to develop de novo a CPG or implement it in a different context. In 2005 the ADAPTE collaboration created some standards for CPG adaptation, in order to improve the quality of its application. Objectives: To describe the evolution of adaptation as an alternative to development or implementation of a CPG and to evaluate the use of recommendations for adaptation in recently published literature. Methods: Using and updating previous review standards (Fervers 2006), we conducted a systematic review of literature to identify and describe the use of adaptation in CPG development or implementation. We included descriptive, comparative and methodological reports describing the use of adaptation as a method for development of CPG. Search will include following databases: MEDLINE (April 2005 to January 2009) and LILACS (January 1982 to January 2009). Search structure: ((”Guidelines as Topic” [Mesh]) OR (”Practice Guidelines as Topic” [Mesh]) OR (”Guideline” [PT]) OR (”Practice Guideline” [PT]) OR (guideline [ti/ab])) AND (adapt* [tw] OR tailor* [tw]). Terms were adapted for LILACS search. Description of searching and literature updating methods, quality and adaptability assessment, and format adaptation and implementation strategies were evaluated and qualified. Results: From 1120 retrieved references (MEDLINE 956, LILACS 154), we selected 27. Eight references use adaptation as alternative for de novo development, 12 as part of implementation process from international level to a national level and seven from a country level to a regional or local context. Less than 15% of the published information of adaptation process covers requested standards. Conclusions: In spite of the dissemination and implementation of adaptation standards, there is not enough coverage of them in published literature.