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APPENDIX

Evidence-based Rating System Used To Determine Strength Of Recommendations

CategoryDefinitionRecommendation
Strength of recommendation 
Strong evidence for efficacy and substantial clinical benefit Strongly recommended 
Strong or moderate evidence for efficacy, but only limited clinical benefit Generally recommended 
Insufficient evidence for efficacy, or efficacy does not outweigh possible adverse consequences Optional 
Moderate evidence against efficacy or for adverse outcome Generally not recommended 
Strong evidence against efficacy or for adverse outcome Never recommended 
Quality of evidence supporting recommendation 
Evidence from at least 1 well-executed randomized controlled trial or 1 rigorously designed laboratory-based experimental study that has been replicated by an independent investigator  
II Evidence from at least 1 well-designed clinical trial without randomization; cohort or case-controlled analytic studies (preferably from >1 center); multiple time-series studies; dramatic results from uncontrolled studies; or some evidence from laboratory experiments  
III Evidence from opinions of respected authorities based on clinical or laboratory experience, descriptive studies, or reports of expert committees  
CategoryDefinitionRecommendation
Strength of recommendation 
Strong evidence for efficacy and substantial clinical benefit Strongly recommended 
Strong or moderate evidence for efficacy, but only limited clinical benefit Generally recommended 
Insufficient evidence for efficacy, or efficacy does not outweigh possible adverse consequences Optional 
Moderate evidence against efficacy or for adverse outcome Generally not recommended 
Strong evidence against efficacy or for adverse outcome Never recommended 
Quality of evidence supporting recommendation 
Evidence from at least 1 well-executed randomized controlled trial or 1 rigorously designed laboratory-based experimental study that has been replicated by an independent investigator  
II Evidence from at least 1 well-designed clinical trial without randomization; cohort or case-controlled analytic studies (preferably from >1 center); multiple time-series studies; dramatic results from uncontrolled studies; or some evidence from laboratory experiments  
III Evidence from opinions of respected authorities based on clinical or laboratory experience, descriptive studies, or reports of expert committees  

Adapted from Centers for Disease Control. 2009 guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children. MMWR Recomm Rep. 2009;58(RR-11):5.

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