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Agilio: Diagnosis and Treatment Guidance April 2025 Update

This update contains 4 significant changes, 20 minor changes and 2 new topics.

Significant Changes:

  • Depression in children — reviewed. A literature search was conducted in February to March 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The definitions of mild, moderate and severe depression have been updated in line with the World Health Organization (WHO) International Classification of Diseases 11th revision (ICD-11). The topic has been reorganised to remove repetition. The topic remains largely based on the National Institute for Health and Care Excellence (NICE) guideline Depression in children and young people: identification and management, which has not had any significant updates since the last revision of this topic, and therefore recommendations are broadly unchanged.
  • Epilepsy — reviewed. A literature search was conducted in January 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has been updated in line with current literature including the National Institute for Health and Care Excellence (NICE) guideline Epilepsies in children, young people and adults (NICE 2025). The term ‘antiepileptic drug’ has been changed to ‘antiseizure medication’. The definition section has been expanded. The recommendations about reproductive health advice have been expanded to include men on antiseizure medication who are sexually active. The topic has undergone minor restructuring to improve clarity and navigation.
  • Syphilis — reviewed. A literature search was conducted in January 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
  • Uveitis — reviewed. A literature search was conducted in February 2025 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 clinical recommendations have been made.

Minor Changes:

  • Analgesia – mild to moderate pain — minor update. Information about high anion gap metabolic acidosis (HAGMA) with concurrent flucloxacillin and paracetamol use has been added in line with the manufacturer’s recommendations.
  • Angina — minor update. Interaction with doacs added to the prescribing information for diltiazem.
  • Anticoagulation – oral — minor update. Added additional information about patients on warfarin who have an INR 5-8 and no bleeding (but are at high risk of bleeding) for clinicians to consider discussing the possibility of using oral vitamin K with a specialist.
  • Atrial fibrillation — minor update. Interaction with doacs added to the prescribing information for diltiazem.
  • Candida – oral — minor update. Dose of fluconazole aligned to BNF.
  • Chilblains— minor update. Depression has been added as an adverse effect of unknown frequency of nifedipine in line with the manufacturer’s instructions.
  • Cow’s milk allergy in children — minor update. Updated link to information from the First Steps Nutrition Trust.
  • Diabetes – type 2 — minor update. Information on which measure of kidney function to use when considering dosage adjustments in people with renal impairment taking alogliptin or vildagliptin was changed from egfr to crcl.
  • Earwax — minor update. Broken links removed.
  • Eczema – atopic — minor update. Revised link to National Eczema Society website.
  • HIV infection and AIDS — minor update. Information added that the British HIV Association (BHIVA) recommends that all people living with HIV aged 40 years or older should be offered statin treatment for primary prevention of CVD irrespective of lipid profile or estimated CVD risk, and that this should be initiated and monitored in primary care, has been added to this topic.
  • Hypertension — minor update. Interaction with doacs added to the prescribing information for diltiazem.
  • Immunizations – travel — minor update. Engerix 20 and 10 updated with correct age ranges for each.
  • Insomnia — minor update. Added information on dosing for Lunivia®.
  • Lipid modification – CVD prevention — minor update. Information added that the British HIV Association (BHIVA) recommends that all people living with HIV aged 40 years or older should be offered statin treatment for primary prevention of CVD irrespective of lipid profile or estimated CVD risk, and that this should be initiated and monitored in primary care, has been added to this topic.
  • Mastitis and breast abscess — minor update. Typographical error corrected in the topic summary.
  • Polycystic ovarian syndrome— minor update. Further information added to the basis for recommendation relating to anti-Mullerian hormone testing.
  • Prostate cancer — minor update. Typographical error in PSA table corrected.
  • Tiredness/fatigue in adults — minor update. Heading added to advise that this topic is being reviewed and updated. A new topic on myalgic encephalomyelitis/chronic fatigue syndrome: diagnosis and management will also be published soon.
  • Urinary tract infection (lower) – men — minor update. Information has been added to the Basis for recommendation of the Management section to clarify that for men, and trans women and non-binary people with a male genitourinary system a trial of daily antibiotic prophylaxis can be considered, and that for women, and trans men and non-binary people with a female urinary system, who are not pregnant, single-dose antibiotic prophylaxis or a trial of daily antibiotic prophylaxis can be considered. Also added ketamine-induced uropathy to the list of potential differential diagnoses.