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Agilio: Diagnosis and Treatment Guidance April 2024 Update

This update contains 6 significant changes, 29 minor changes and 1 new topic.

Significant Changes:

  • Breast cancer – managing FH — reviewed. A literature search was conducted in January 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. More detail on risk factors has been added. No major changes to clinical recommendations have been made.
  • Cirrhosis — reviewed. A literature search was conducted in January 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last version of this topic. The recommendations have been updated in line with current evidence in the literature. A section on the assessment of a person with suspected cirrhosis has been added. The criteria on when to consider palliative care referral have been expanded. The recommendations on primary care management of a person with cirrhosis have been updated and expanded.
  • Depression – antenatal and postnatal — reviewed. A literature search was conducted in October 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.
  • Impetigo — reviewed. A literature search was conducted in December 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made, but the topic has been restructured.
  • Otitis media – acute — reviewed. A literature search was conducted in January 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to the topic, with no major changes to the clinical recommendations.
  • Pyelonephritis – acute — reviewed. A literature search was conducted in November 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.

Minor Changes:

  • Anaemia – B12 and folate deficiency — minor update. Recommendations from the NICE guideline Vitamin B12 deficiency in over 16s: diagnosis and management have been incorporated into this topic.
  • Aphthous ulcer — minor update. Adverse effects of doxycycline updated in line with the manufacturer’s SPC.
  • Bites – human and animal — minor update. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Bronchiectasis — minor update. Information on the use of fluoroquinolones was added to the ciprofloxacin prescribing section in line with a review published by the MHRA. Fixed eruption added as an adverse effect for doxycycline as per the manufacturer’s SPC.
  • Chest infections – adult — minor update. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Chlamydia — minor update. Information on the use of fluoroquinolones was added to the ofloxacin prescribing section in line with a review published by the MHRA. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Chronic kidney disease — minor update. A minor typographical error has been corrected.
  • Cough – acute with chest signs in children — minor update. Adverse effects of doxycycline updated in line with manufacturer’s SPC.
  • Diabetes type 2 — minor update. Phimosis has been added as an adverse effect of dapagliflozin in line with the manufacturer’s SPC.
  • Dyspepsia – proven peptic ulcer — minor update. Information on the use of fluoroquinolones was added to the levofloxacin prescribing section in line with a review published by the MHRA.
  • Dyspepsia – proven functional — minor update. Information on the use of fluoroquinolones was added to the levofloxacin prescribing section in line with a review published by the MHRA.
  • Dyspepsia – unidentified cause — minor update. Information on the use of fluoroquinolones was added to the levofloxacin prescribing section in line with a review published by the MHRA.
  • Earwax — minor update. A link has been provided to a patient information leaflet and information on bulb syringing has been added to the basis for recommendation in the section on how to remove earwax.
  • Eczema — minor update. Link added to the National Eczema Society regarding the advice not to use aqueous cream as an emollient.
  • Gastroenteritis — minor update. Information that people with confirmed cryptosporidiosis or giardiasis should not go swimming for 2 weeks after the last episode of diarrhoea has also been added to the sections on management of confirmed causes.
  • Gonorrhoea — minor update. Information on the use of fluoroquinolones was added to the ciprofloxacin prescribing section in line with a review published by the MHRA.
  • Heart failure – chronic — minor update. Genital infections have been added as an adverse effect of dapagliflozin in line with the manufacturer’s SPC.
  • Leg ulcer – venous — minor update. Adverse effects of doxycycline updated in line with manufacturer’s SPC.
  • Lyme disease — minor update. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Pelvic inflammatory disease — minor update. Information on the use of fluoroquinolones was added to the levofloxacin and moxifloxacin prescribing sections in line with a review published by the MHRA. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Poisoning and overdose — minor update. Information about the Specialist Pharmacy Service (SPS) has been updated.
  • Rosacea — minor update. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s updated SPC.
  • Scabies — minor update. Ivermectin 3 mg has been licensed for use in the treatment of scabies. The management advice has been updated to include this information and new prescribing advice has also been added.
  • Scrotal pain — minor update. Information on the use of fluoroquinolones was added to the ofloxacin and levofloxacin prescribing sections in line with a review published by the MHRA. Adverse effects of doxycycline updated in line with the manufacturer’s SPC.
  • Sinusitis — minor update. Fixed eruption added as an adverse effect of doxycycline as per the manufacturer’s SPC.
  • Smoking cessation — minor update. Added information about the risk of panic attacks with bupropion in line with an update of the manufacturer’s SPC.
  • Spondyloarthritis and psoriatic arthropathy — minor update. Some minor formatting changes have been made to this topic.
  • Urethritis – male — minor update. Information on the use of fluoroquinolones was added to the ofloxacin prescribing section in line with a review published by the MHRA. Adverse effects of doxycycline updated in line with the manufacturer’s SPC.
  • Urticaria — minor update. A minor typographical error has been corrected.

New Topic:

  • Abortion — this is a new Prodigy topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.