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Agilio: Diagnosis and Treatment Guidance March 2024 Update

This update contains 9 significant changes, 20 minor changes and 1 new topic.

Significant Changes:

  • Amenorrhoea — reviewed. A literature search was conducted in January 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. No major changes to recommendations have been made; however, the definitions of primary and secondary amenorrhoea have been amended to reflect expert opinion in guidelines and recent review articles.
  • Dermatitis – contact — 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. No major changes to recommendations have been made.
  • DVT prevention for travellers — 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 this topic. The moderate risk category has been removed in line with the latest guidelines from the British Society for Haematology and the American Society of Hematology, and accordingly minor changes to the recommendations have been made. A section on pregnancy has been added.
  • Febrile seizure — 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 significant changes to recommendations have been made.
  • MRSA in primary care — 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. Minor structural changes have been made to the topic to align with up-to-date evidence, with no changes to the clinical recommendations.
  • Polymyalgia rheumatica — 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. No major changes to recommendations have been made.
  • Rheumatoid arthritis — 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 the topic.
  • Sepsis — reviewed. A literature search was conducted in February 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. Recommendations have been aligned to the updated NICE guideline Suspected sepsis: recognition, diagnosis and early management.
  • Vaginal discharge — 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 clinical recommendations have been made.

Minor Changes:

  • Benzodiazepine and z-drug withdrawal — minor update. Added information about prescribing diazepam to people who are breastfeeding with caution.
  • Contraception – sterilization — minor update. Information that Essure® micro-inserts have been discontinued has been added to this topic.
  • Coronavirus – COVID 19 — minor update. Link added to the JCVI statement on COVID-19 vaccination in spring 2024.
  • Cough – acute with chest signs in children — minor update. Neurotoxicity has been added as a possible adverse effect of cefaclor treatment in line with the manufacturer’s updated SPC.
  • Dyspepsia – proven functional — minor update. Link added to the JCVI statement on COVID-19 vaccination in spring 2024.
  • Dyspepsia – unidentified cause — minor update. Doses of H2-receptor antagonists aligned to BNF.
  • Generalized Anxiety Disorder — minor update. An adverse effect of hyperprolactinaemia relating to Citalopram has been added in line with an update to the manufacturer’s SPC. Interaction between pregabalin and morphine sulfate has been added in line with an update to the manufacturer’s SPC. Added information about prescribing diazepam to people who are breastfeeding with caution.
  • Lyme disease — minor update. Infantile hypertrophic pyloric stenosis added as a possible adverse effect of azithromycin after use in neonates.
  • Meningitis – bacterial meningitis and meningococcal disease — minor update. The risk stratification tables for people with suspected sepsis have been updated in line with the updated NICE guideline Sepsis: recognition, diagnosis and early management.
  • Nausea/vomiting in pregnancy — minor update. Topic updated to include recommendations from the RCOG, 2024 Guideline The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69).
  • Neuropathic pain – drug treatment — minor update. Interaction between gabapentin/pregabalin and morphine sulfate has been added in line with an update to the manufacturer’s SPC.
  • NSAIDs – prescribing issues — minor update. Kounis syndrome has been added as a possible adverse effect of ibuprofen in line with the manufacturer’s updated SPC.
  • Obsessive-compulsive disorder— minor update. An adverse effect of hyperprolactinaemia relating to Citalopram has been added in line with an update to the manufacturer’s SPC.
  • Palliative care – cough — minor update. Adverse effects of morphine have been added in line with an update to the manufacturer’s SPC.
  • Palliative care – dyspnoea — minor update. Adverse effects of morphine have been added in line with an update to the manufacturer’s SPC.
  • Polycystic ovary syndrome— minor update. Updated the topic in line with recommendations in the International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023 issued by the International PCOS Network. Updates include; refinements to the diagnostic criteria have been made. New advice on the assessment of PCOS in the post-menopause has been added. All women with PCOS should be offered a lipid profile and glycaemic testing with an oral glucose tolerance test regardless of BMI.
  • Pressure ulcers — minor update. Broken link to Waterflow score updated.
  • Restless legs syndrome — minor update. Adverse effects of ropinirole and rotigotine updated in line with updated manufacturer’s SPC.
  • Varicose veins — minor update. A link has been to the NHS England Decision support tool: making a decision about treatment for varicose veins.
  • Whooping cough — minor update. Infantile hypertrophic pyloric stenosis added as a possible adverse effect of azithromycin after use in neonates.

New Topic:

  • Adult malnutrition — new topic. A literature search was conducted in November 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.