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WHO 2019 guidelines on drug-resistant tuberculosis treatment: based on evidence or expert opinion?

Since 2011, the World Health Organization (WHO) has used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for grading quality of evidence [1, 2] to update guidelines for the management of drug-resistant tuberculosis (DR-TB). This represents an undeniable improvement towards evidence-based recommendations compared to previous guidelines, which were primarily based on expert opinion [3]. However, some aspects of guideline development remain unclear. In our opinion, the WHO 2019 consolidated guidelines on DR-TB treatment [4] have raised some concerns in the way recommendations were drawn from the evidence evaluated to answer specific PICO (Patient, Intervention, Comparator, Outcome) questions. World Health Organization guidelines on drug-resistant tuberculosis should make a clear distinction between evidence, expert opinion and assumptions to allow appreciation of the uncertainty around the recommendations http://bit.ly/2FHxmyW