The Philippine Clinical Practice Guideline on the Diagnosis and ...

Categories reflecting the strength of recommendation
Appendix 1
Grading System for Recommendations
GRADE DEFINITION
A Good evidence to support a recommendation for use
B Moderate evidence to support a recommendation for use
C Poor evidence to support a recommendation for or against use
D Moderate evidence to support a recommendation against use
E Good evidence to support a recommendation against use
Appendix 2
Quality filters in assessing the evidence from the literature
1. Studies on effectiveness of treatment and accuracy of diagnostic tests: Level of quality of evidence
I Evidence from at least one properly randomized controlled trial.
II Evidence from at least one well-designed clinical trial without randomization, from cohort or casecontrolled
analytic studies (preferable from more than one center), from multiple time-series studies, or
from dramatic results in uncontrolled experiments.
III Evidence from opinions of respected authorities on the basis of clinical experience, descriptive studies, or
reports of expert committees.
2. Studies on prognosis or causation: Criteria for assessing quality of evidence
A. An inception cohort was chosen.
B. Reproducible and inclusion and exclusion criteria were used.
C. Follow-up was complete for at least 80% of subjects.
D. Statistical adjustment was carried out for confounders or extraneous factors.
E. Reproducible descriptions of outcome measures were used.
Level of Quality of Evidence:
I. All of the criteria were satisfied.
II. An inception cohort was selected but only 3 of 4 remaining criteria were satisfied.
III. An inception cohort was selected but only 2 of 4 remaining criteria were satisfied.
IV. An inception cohort was selected but only 1 of 4 remaining criteria was satisfied
V. None of the 5 criteria was met.
Appendix 3
Laboratory criteria for significant pyuria and bacteriuria
Strength of Cut-off for Strength of
Syndrome
Cut-off for pyuria* recommendation bacteriuria recommendation
1. Acute uncomplicated a. ≥ 8 pus cells/ mm
cystitis
3 C
≥ 100 cfu/ml
A
b. ≥ 5 pus cells/ hpf C
≥ 1000 cfu/ml
(clinical trials)
C
2. Acute uncomplicated
pyelonephritis
≥ 5 pus cells/hpf C ≥ 10,000 cfu/ml B
3.Asymptomatic bacteriuria > 10 pus cells/ hpf C ≥ 100,000 cfu/ml A
4. Complicated UTI ≥ 100,000 cfu/ml
(with exceptions) C
5. UTI in males a. ≥ 10 pus
cells/mm 3
C ≥ 1000 cfu/ml C
b. ≥ 5 pus cells/ hpf C
*Pus cell per mm 3 and per hpf refer to number found in uncentrifuged and centrifuged urine respectively.