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Agilio: Diagnosis and Treatment Guidance September 2024 Update

This update contains 7 significant changes and 30 minor changes.

Significant Changes:

  • Cerebral palsy — reviewed. A literature search was conducted in June 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 no major changes to the recommendations.
  • Cow’s milk protein allergy in children — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
  • Gallstones — reviewed. A literature search was conducted in April 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.
  • Hepatitis A — reviewed. A literature search was conducted in May 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.
  • Prostatitis – chronic — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
  • Retinal detachment — reviewed. A literature search was conducted in July 2024 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 undergone minor restructuring, and the recommendations on the diagnosis, assessment and management of suspected retinal detachment have been updated to align with current evidence.
  • Superficial vein thrombosis (superficial thrombophlebitis) — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature, including to consider arranging urgent duplex ultrasound scan if there is suspected superficial vein thrombosis of the lower limb. Minor structural changes have been made to improve clarity and navigation.

Minor Changes:     

  • Anaemia – iron deficiency — minor update. The summary updated to include FIT testing referral criteria and to align with the management section on referral.
  • Angio-oedema and anaphylaxis— minor update. Details of updated NICE quality standards have been added to this topic.
  • Bites – human and animal — minor update. An adverse effect of co-amoxiclav has been added as per the manufacturer’s SPC.
  • Bronchiectasis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Cellulitis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Chronic kidney disease — minor update. Examples of structural abnormalities, and other abnormalities due to tubular disorders have been added to the bullet point on markers of kidney damage in the section on Definition.
  • Chronic obstructive pulmonary disease — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Contraception – combined hormonal methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
  • Contraception – emergency— minor update. Removed information about IUS expiry after 6 years for Mirena® as this is licensed for 8 years of contraception.
  • Contraception – IUC — minor update. Length of use of LNG-IUD revised to 8 years maximum for Levosert® in line with an update to the manufacturer’s summary of product characteristics.
  • Contraception – progestogen-only methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
  • Cough – acute with chest signs in children — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Diabetes – type 2— minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics. Information that HbA1c may be used to diagnose type 2 diabetes in children and young people has been added to this topic in line with the updated International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline.
  • Epilepsy — minor update. Broken links updated to MHRA information on topiramate in pregnancy.
  • Heart failure – chronic — minor update. Update in wording on monitoring eGFR and creatinine after starting or titrating of renin-angiotensin system antagonists.
  • Hypothyroidism — minor update. Minor typographical error corrected.
  • Immunizations – seasonal influenza — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
  • Mastitis and breast abscess — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC. Added information about considering the use of cold compresses for retroareolar inflammation.
  • Migraine — minor update. A typographical error has been corrected.
  • Neuropathic pain – drug treatment— minor update. Removed information regarding capsaicin cream as it is currently unavailable.
  • Obesity — minor update. Added information about endoscopic sleeve gastroplasty as an option for people who may be high risk for bariatric surgery, who decline bariatric surgery because of the associated risk, or where this procedure may prevent progression of obesity and associated comorbidities. Added information about tirzepatide (Mounjaro®) and risks of interaction with oral contraception in individuals who are overweight or obese.
  • Otitis media – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Post-herpetic neuralgia — minor update. Removed capsaicin cream recommendation, as this is currently unavailable.
  • Prostate cancer — minor update. Following communication from an expert reviewer the topic has been updated to include recent research specifically on the asymptomatic nature of the presentation of prostate cancer, mortality and ethincity, prognostic models, change of terminology from Gleason score to Grade Group, additional information about PSA testing in men over the age of 79, and refinements to the outline of the active surveillance approach and applicability to different Cambridge Prognostic Groups.
  • Pyelonephritis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Restless legs syndrome — minor update. Adverse effects of pramipexole updated in line with updated manufacturer’s SPC.
  • Scrotal pain and swelling — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Sepsis — minor update. A minor typographical error has been corrected.
  • Sinusitis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
  • Smoking cessation — minor update. Alopecia added as an adverse effect of bupropion, in line with the manufacturer’s updated SPC.