Agilio: Diagnosis and Treatment Guidance June 2023 Update

This update contains 6 significant changes, 21 minor changes and 1 new topic.

Significant Changes:

Acne vulgaris — reviewed. A literature search was conducted in March 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. The term ‘Propionibacterium acnes‘ (P. acnes) has been altered to ‘Cutibacterium acnes‘ (C. acnes) to reflect the current bacterial taxonomy. Reference to topical isotretinoin preparations has been removed as these are no longer available in the UK. No changes were made to clinical recommendations.
Bell’s palsy — reviewed. A literature search was conducted in February 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
Child maltreatment – recognition and management — 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 the recommendations have been made. The topic has undergone minor restructuring.
Conduct disorders in children and young people — 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. Definitions have been updated in line with the 11th revision of the World Health Organization’s International Classification of Diseases (ICD-11). The topic has undergone minor restructuring, and additional recommendations regarding assessment in primary care have been added. No major changes to the recommendations have been made.
Fungal nail infection — 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 were made to recommendations.
Learning disabilities — reviewed. A literature search was conducted in March 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomised controlled trials published since the last revision of the topic. The topic has been updated to reflect current evidence in the literature. No major changes to the recommendations have been made.

Minor Changes:

Bites – human and animal — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Blepharitis — minor update. Details of alternative lid cleansers have been added.
Bronchiectasis — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Cellulitis – acute — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Chronic kidney disease — minor update. Recommendations on lipid management of people with CKD aligned with updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification.
Contraception – IUC — minor update. Updated in line with the Faculty of Sexual and Reproductive Healthcare (FSRH) updated guideline FSRH Intrauterine Contraception [FSRH, 2023].
Cough – acute with chest signs in children — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
CVD risk assessment and management — minor update. Recommendations aligned with updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification.
Diverticular disease — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Earwax — minor update. Updated based on an update to Rotherham Primary Ear Care and Audiology Service, 2022 Ear Irrigation guideline.
Epilepsy — minor update. Minor text changes made to the information that valproate should not be used in women or girls who are able to have children.
Erectile dysfunction — minor update. Information on prescribing PDE-5 inhibitors on the NHS has been updated and a link to the NHS Electronic Drug Tariff added.
Incontinence – urinary, in women — minor update. Minor typographical error corrected.
Leg ulcer – venous — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Lipid modification – CVD prevention — minor update. QoF indicators have been updated in line with the Quality and Outcomes Framework guidance for 2023/24. Recommendations aligned with updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification.
Mastitis and breast abscess — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Obesity — minor update. The recommendation from the NICE technology appraisal Semaglutide for managing overweight and obesity [TA875] has been added to the management section of this topic. It is however, important to note that semaglutide is not currently available. It will be available after launch of the drug in England is confirmed by the manufacturer.
Otitis media – acute — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Pyelonephritis – acute — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Scrotal pain and swelling — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.
Sinusitis — minor update. Added potential adverse effects of co-amoxiclav to include Kounis syndrome (an allergic reaction which can result in myocardial infarction), aseptic meningitis, linear IgA disease (renal deposition of IgA), and drug-induced enterocolitis syndrome (all of unknown frequency). These adverse effects were noted in an update to the manufacturer’s summary of product characteristics.

New Topic:

Abdominal aortic aneurysm screening — this is a new Agilio DTG topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.