Article type
Abstract
"Introduction: Clinical practice recommendations for the diagnosis, treatment, and management of human brucellosis are globally scarce, exacerbated by a lack of evidence, underreporting of cases, and historical neglect of the topic. In Brazil, the public health system faces challenges due to uncertainties arising from asymptomatic cases, diagnostic difficulties, underreporting, and a lack of clear guidelines for suspected cases.
Objective: To describe the systematic literature review process used to construct recommendations for the human brucellosis guideline for the Brazilian health system.
Methods: Five research questions were formulated in the PICO format to guide the search, selection, and evaluation of evidence for diagnosis, treatment (adults, children, and pregnant), and post-exposure prophylaxis (PEP) following PRISMA guidelines. The risk of bias was assessed based on the designs of the included studies, and the certainty of evidence was verified using the GRADE and CINeMA approaches. Searches were conducted on the Medline/PubMed, LILACS/VHL, Embase, and Cochrane databases, as well as grey literature. GRADEpro GDT was employed to formulate the recommendations.
Results: The recommendation for diagnosis was derived from a review of 38 studies, emphasizing the diagnostic strategies of Rose Bengal, ELISA, and PCR. The review for treatment in adults included 31 randomized clinical trials, and a network meta-analysis indicated the superiority of the doxycycline and aminoglycosides combination. Evidence for treatment in children and pregnant is limited, concentrated in observational studies reporting the frequent use of the sulfamethoxazole-trimethoprim + rifampicin regimen. While PEP is employed in high-risk accidents following the CDC-USA approach, the literature does not establish the effectiveness of this practice reported in non-comparative observational studies. In all reviews, evidence with a high risk of bias and low certainty of evidence predominated, resulting in recommendations with a low strength of recommendation.
Conclusion: This guideline represents an important opportunity to translate evidence and develop a robust and transparent document capable of standardizing conduct and disseminating effective strategies. The expectation is that implementing these guidelines will promote equity and access to the best evidence-based practices.
Relevance and Importance to Patients: Utilizing evidence to generate recommendations is essential to ensuring the best care for patients. "
Objective: To describe the systematic literature review process used to construct recommendations for the human brucellosis guideline for the Brazilian health system.
Methods: Five research questions were formulated in the PICO format to guide the search, selection, and evaluation of evidence for diagnosis, treatment (adults, children, and pregnant), and post-exposure prophylaxis (PEP) following PRISMA guidelines. The risk of bias was assessed based on the designs of the included studies, and the certainty of evidence was verified using the GRADE and CINeMA approaches. Searches were conducted on the Medline/PubMed, LILACS/VHL, Embase, and Cochrane databases, as well as grey literature. GRADEpro GDT was employed to formulate the recommendations.
Results: The recommendation for diagnosis was derived from a review of 38 studies, emphasizing the diagnostic strategies of Rose Bengal, ELISA, and PCR. The review for treatment in adults included 31 randomized clinical trials, and a network meta-analysis indicated the superiority of the doxycycline and aminoglycosides combination. Evidence for treatment in children and pregnant is limited, concentrated in observational studies reporting the frequent use of the sulfamethoxazole-trimethoprim + rifampicin regimen. While PEP is employed in high-risk accidents following the CDC-USA approach, the literature does not establish the effectiveness of this practice reported in non-comparative observational studies. In all reviews, evidence with a high risk of bias and low certainty of evidence predominated, resulting in recommendations with a low strength of recommendation.
Conclusion: This guideline represents an important opportunity to translate evidence and develop a robust and transparent document capable of standardizing conduct and disseminating effective strategies. The expectation is that implementing these guidelines will promote equity and access to the best evidence-based practices.
Relevance and Importance to Patients: Utilizing evidence to generate recommendations is essential to ensuring the best care for patients. "