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Agilio: Diagnosis and Treatment Guidance July 2023 Update

This update contains 8 significant changes and 15 minor changes.

Significant Changes:

  • Anaemia – iron deficiency — reviewed. A literature search was conducted in April 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.
  • Autism in children — reviewed. A literature search was conducted in April 2023 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 evidence in the literature. The topic has undergone minor restructuring to improve clarity and navigation. The section on Management of behaviour that challenges in the Scenario on Management of confirmed autism has been removed, and a link made to the Agilio topic on Learning disabilities, which covers this in detail.
  • Benzodiazepine and z-drug withdrawal — reviewed. A literature search was conducted in April 2023 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 no changes to the recommendations.
  • Feverish children – risk assessment and management — reviewed. A literature search was conducted in June 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. This topic has been merged with the topic Feverish children – management, with a new scenario created covering the management of fever in children aged up to 5 years. A section on specific illnesses to consider when assessing fever has also been added.
  • Fungal skin infection – foot — reviewed. A literature search was conducted in June 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.
  • Fungal skin infection – scalp — reviewed. A literature search was conducted in March 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.
  • Immunization – seasonal influenza — reviewed. The management section has been updated to align with the NHS immunisation programme 2023 to 2024.
  • Smoking cessation — reviewed. A literature search was conducted in March to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor changes to prescribing information in line with updated manufacturer guidance, and the British National Formulary. The carbon monoxide breath test result that should be used to identify women who require referral to NHS Stop Smoking Services has been changed from 7 ppm and above to 4 ppm and above.

Minor Changes:

  • Allergic rhinitis — minor update. Cetirizine doses for people with renal impairment updated in line with BNF.
  • Angina — minor update. Information that nitrates should be prescribed with caution in people with hypoxaemia due to severe anaemia has been added to the prescribing information section of this topic.
  • Asthma — minor update. The term muscarinic agent in the prescribing information section has been changed to muscarinic antagonist for clarification.
  • Cow’s milk allergy in children — minor update. Cetirizine doses for people with renal impairment updated in line with BNF.
  • Deep vein thrombosis — minor update. The dose regimen of enoxaparin has been updated in line with the summary of the manufacturer’s product characteristics.
  • Diarrhoea – adult’s assessment — minor update. A recommendation to ask about sexual history, particularly in men who have sex with men, has been added to this topic in line with the British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023.
  • Gastroenteritis — minor update. A recommendation to ask about sexual history, particularly in men who have sex with men, has been added to this topic in line with the British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023.
  • Gout — minor update. Information on cautions when prescribing febuxostat updated in line with MHRA drug safety update to advise caution when prescribing febuxostat to people with cardiovascular disorders, particularly in those with evidence of high urate crystal and tophi burden or those initiating urate-lowering therapy.
  • Heart failure – chronic — minor update. Information that dapagliflozin is recommended by the National Institute for Health and Care Excellence (NICE) as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction on the advice of a heart failure specialist has been added to this topic in line with the NICE technology appraisal Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction. Minor structural changes have also been made to the prescribing information section.
  • Immunization – childhood — minor update. The HPV vaccination schedule has been updated in line with the updated chapter on Human papillomavirus (HPV) in the UKHSA document Immunisation against infectious disease (the Green Book) which now recommends a one-dose schedule for people aged under 25 years.
  • Itch – widespread — minor update. Cetirizine doses for people with renal impairment updated in line with BNF.
  • Palliative care – general issues — minor update. Replaced a link to the updated Prognostic Indicator Guidance.
  • Pulmonary embolism — minor update. The dose regimen of enoxaparin has been updated in line with the summary of the manufacturer’s product characteristics.
  • Urinary tract infection (lower) – women — minor update. The information relating to nitrofurantoin drug interactions has been updated in line with the summary of manufacturer’s product characteristics. The interaction with dapsone and topical prilocaine has been removed.
  • Urticaria — minor update. Cetirizine doses for people with renal impairment updated in line with BNF.