The methodological quality of dengue clinical practice guidelines globally. A systematic review

Abstract

Objective This study aimed to systematically review the methodological quality of dengue clinical practice guidelines (CPGs) available globally.

Methods This systematic review included CPGs on dengue clinical management (clinical diagnosis, investigation and treatment), and the development process of the guidelines, required to be evidence-based and including an expert review process. An electronic search was performed using Google, Google Scholar and PubMed. The search was last performed in September 2025. No language restriction was imposed. The selection of CPGs and cross-checking of data extracted were performed by two independent reviewers with a third to resolve any discrepancies. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) was used to assess the quality of CPGs by four independent reviewers.

Results A total of 29 CPGs published from 2009-2025 in 18 countries were included for review. Overall, six CPGs rated as high quality. Among these six CPGs, only three reported the recommendations with GRADE. Four CPGs adapted other CPGs without transparent review process. Majority of the CPGs fail to demonstrate a robust scientific development process.

Conclusion Despite the variability in the quality of the CPGs assessed in this review, several high-quality guidelines were identified as suitable for use. In contrast, a number of CPGs were found to rely heavily on adaptations of existing guidelines while lacking sufficient methodological rigour. Therefore, CPGs that adapt recommendations from other sources should still undertake a full and systematic development process consistent with the AGREE II framework.