Systematic reviews and evidence synthesis to inform a WHO guideline on prevention and management of Acute Rheumatic Fever and Rheumatic Heart Disease

Description

Despite the near disappearance of Rheumatic Heart Disease (RHD) in developed high-income countries, RHD remains the leading cause of heart failure in children and adolescents living in low- and middle-income countries (Marijon et al., 2012). RHD is caused by Acute Rheumatic Fever (ARF), which is an autoimmune response triggered by group A beta-haemolytic streptococcus (GABHS) infection. Antibiotic treatment of patients with GABHS reduces the progression of GABHS infection to ARF (Robertson et al., 2005).

The Institute for Evidence-Based Healthcare (IEBH), represented by the Centre for Research Excellence on Minimising Antibiotic Resistance in the Community (CRE-MARC), at Bond University, was contracted to conduct systematic reviews and evidence synthesis to inform a WHO guideline on the prevention and management of RHD and ARF by answering the following 4 questions posed by the World Health Organisation (WHO).

• Question 1: Among children, adolescents, and adults with sore throat, what is the diagnostic accuracy of combinations of signs and symptoms (as compared to microbiological tests) to identify streptococcal infection?
• Question 2: Should all children, adolescents and adults with laboratory-confirmed streptococcal pharyngitis be treated with antibiotics in order to prevent RF/RHD? If so, what is the best choice of antibiotics for treatment of lab-confirmed streptococcal pharyngitis?
• Question 3: Where confirmation by laboratory diagnosis (including rapid Strep A antigen test) is not possible, should children, adolescents and adults with clinically suspected streptococcal pharyngitis be treated with antibiotics in order to prevent RF/RHD? If so, what is the best choice of antibiotics for treatment of clinically suspected streptococcal pharyngitis?
• Question 4: Should all children, adolescents and adults presenting with sore throat be treated with antibiotics in order to prevent RF/RHD? If so, what is the best choice of antibiotics for treatment of sore throat?

Evidence for each question was synthesised and summarised in one of the following ways:
1. Existing review appraisal and synthesis: if an existing, up-to-date, high-quality systematic review directly addressing the question is available, the review will be appraised, synthesised, and summarised, supplemented by a search for any includable studies published after the reviews search date.
2. Existing review appraisal, evidence re-analysis and synthesis: if an existing, up-to-date, high-quality systematic review that did not explore the question directly but has relevant data to answer the question is available the review will be appraised, and the relevant data will be re-analysed, synthesised, and summarised.
3. Existing review update and synthesis (if updating is required): if an existing high-quality systematic review is available, but it is out-of-date, an update will be conducted.
4. De novo systematic review: If the above-mentioned update (point number 3) for the identified systematic review was not feasible or no systematic reviews that directly or indirectly address the review question are available, a new systematic review will be conducted following the standard Cochrane procedures.

Period	1 Jul 2022 → 30 Mar 2023
Work for	World Health Organization, Switzerland
Degree of Recognition	International