Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on community-acquired pneumonia — assessment, diagnosis and antibiotic prescribing

Abstract

This Evidence-to-Recommendation (EtR) framework underpins the Agency for Care Effectiveness Clinical Guideline (ACG) for the management of non-severe community-acquired pneumonia (CAP) in adults, providing the rationale and justification for the guideline recommendations. Pneumonia remains a leading cause of morbidity and mortality in Singapore, accounting for 4.6% of hospitalisations and 23.0% of deaths in 2024. The ACG addresses management gaps that contribute to poor clinical outcomes, including diagnostic uncertainty, inappropriate prescribing and suboptimal treatment. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop five evidence-based recommendations covering the assessment, diagnosis and antibiotic management of CAP. This EtR framework summarises the factors that informed the direction and strength of the ACG recommendations, providing the rationale and decisions made by the Expert Group to aid clinicians in understanding and applying the recommendations in the management of CAP. The ACG can be found at https://go.gov.sg/acg-cap.