Evidence-based Rating System Used To Determine Strength Of Recommendations
| Category . | Definition . | Recommendation . |
|---|---|---|
| Strength of recommendation | ||
| A | Strong evidence for efficacy and substantial clinical benefit | Strongly recommended |
| B | Strong or moderate evidence for efficacy, but only limited clinical benefit | Generally recommended |
| C | Insufficient evidence for efficacy, or efficacy does not outweigh possible adverse consequences | Optional |
| D | Moderate evidence against efficacy or for adverse outcome | Generally not recommended |
| E | Strong evidence against efficacy or for adverse outcome | Never recommended |
| Quality of evidence supporting recommendation | ||
| I | 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 | |
| Category . | Definition . | Recommendation . |
|---|---|---|
| Strength of recommendation | ||
| A | Strong evidence for efficacy and substantial clinical benefit | Strongly recommended |
| B | Strong or moderate evidence for efficacy, but only limited clinical benefit | Generally recommended |
| C | Insufficient evidence for efficacy, or efficacy does not outweigh possible adverse consequences | Optional |
| D | Moderate evidence against efficacy or for adverse outcome | Generally not recommended |
| E | Strong evidence against efficacy or for adverse outcome | Never recommended |
| Quality of evidence supporting recommendation | ||
| I | 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.