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Agilio: Diagnosis and Treatment Guidance March 2025 Update

This update contains 5 significant changes, 30 minor changes and 1 new topic.

Significant Changes: 

  • Chest infections – adult — reviewed. A literature search was conducted in December 2024 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.
  • Deep vein thrombosis — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No changes to clinical recommendations have been made.
  • Hypertension in pregnancy — reviewed. A literature search was conducted in November 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. A minor correction was made to the figures quoted relating to prognosis in future pregnancies. Given that there is no strong evidence that ACE inhibitor or ARB use in the first trimester poses a teratogenic risk to the fetus, a recommendation was added to provide reassurance where inadvertent exposure has occurred. Recommendations were altered regarding culture and sensitivity testing for women with asymptomatic bacteriuria, to align the topic with the latest guidance from NHS England.
  • Obesity — 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. The topic has been updated in line with the National Institute for Health and Care Excellence (NICE) new guideline Overweight and obesity management.
  • Restless leg — 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. No major changes to the recommendations have been made.

Minor Changes:

  • ADHD — minor update. Added information regarding gambling-related harms as a potential issue to consider in adults with ADHD in line with the NICE guideline Gambling-related harms: identification, assessment and management.
  • Alcohol – problem drinking — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Antenatal care — minor update. A recommendation to reassure people with a BMI over 25 kg/m2 planning to become pregnant or in the first 12 weeks of pregnancy that they do not need to take more than 400 micrograms of folic acid a day unless they have an increased risk of having a baby with a neural tube defect or other congenital malformation has been added to this topic in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
  • Bipolar disorder — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025. Minor typographical error corrected.
  • Boils — minor update. Duration of antibiotic treatment updated to 5–7 days.
  • Chlamydia — minor update. Detail added that if necessary, test of cure in pregnant women should be deferred for at least 3 weeks after treatment is completed.
  • COPD — minor update. Further detail added on which second line antibiotics to consider when prescribing for an acute exacerbation.
  • Corticosteroids – oral — minor update. Revised physiological dose equivalent of prednisolone. Revised timescale of taper of oral steroids from initial course of three weeks to four weeks in line with NICE guideline Adrenal insufficiency: identification and management NICE, 2024.
  • Depression — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Diarrhoea – antibiotics associated — minor update. The wording has been updated to clarify treatment options for subsequent C. difficile infection episodes after initial symptom resolution.
  • Fungal skin infection – scalp — minor update. Information about selenium sulfide shampoo has been removed from this topic as it has been discontinued.
  • Generalised anxiety disorder — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Heart failure – chronic — minor update. Intestinal angioedema been added as an adverse effect of candesartan in line with the manufacturer’s SPC.
  • Homelessness — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Insect bites and stings — minor update. Minor typographical error corrected.
  • Insomnia — minor update. Added information on the availability of a new drug option for the treatment of insomnia, Lunivia®.
  • Mastitis and breast abscess — minor update. External reviewers comments on a range of issues relating to management and diagnosis of mastitis.
  • Mental health in students — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Opioid dependence — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Parkinson’s disease — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Paronychia — minor update. Duration of antibiotic treatment updated to 5–7 days.
  • Pre-conception advice and management — minor update. A recommendation to reassure people with a BMI over 25 kg/m2 planning to become pregnant or in the first 12 weeks of pregnancy that they do not need to take more than 400 micrograms of folic acid a day unless they have an increased risk of having a baby with a neural tube defect or other congenital malformation has been added to this topic in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
  • Psychosis — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • PTSD — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Roundworm — minor update. Information on mebendazole has been updated in line with the British National Formulary.
  • Self-harm — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
  • Smoking cessation — minor update. Added information on the potential use of cytisinicline as a stop smoking intervention to align with the updated NICE guideline NG209 Tobacco: preventing uptake, promoting quitting and treating dependence
  • Threadworm — minor update. The section on mebendazole has been updated in line with the Roundworm topic.
  • Urinary tract infection (lower) – women — minor update. Revised wording on nitrofurantoin in pregnancy to ensure consistency between prescribing sections.
  • Whitlow — minor update. Duration of antibiotic treatment updated to 5–7 days.

New Topic:

  • Hypokalaemia — this is a new Prodigy topic. A literature review was performed in September 2024. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.