Agilio: Diagnosis and Treatment Guidance's DTG February 2024 Update

This update contains 6 significant changes, 87 minor changes and 1 new topic.

Significant Changes:

Diarrhoea – adults assessment — reviewed. A literature search was conducted in October 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. There are no changes to the recommendations.
Mumps — reviewed. A literature search was conducted in November 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.
Neck pain – whiplash injury — reviewed. A literature search was conducted in November 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made, including the addition of short sections on prevalence, causes and complications, but no major changes to the recommendations.
Osteoarthritis — 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 recommendations and basis for recommendation sections have been updated in line with current evidence in the literature.
Sinusitis — reviewed. A literature search was conducted in September 2023 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 clinical recommendations have been made. However, the classification of chronic sinusitis has been updated in line with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020).
UTI – women — 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 recommendations have been updated in line with current evidence in the literature. The criteria used to diagnose urinary tract infection (UTI) and when to arrange dipstick testing of urine have been updated in line with the UK Health Security Agency (UKHSA) quick reference tool for primary care. The Scenario on the management of UTI with haematuria has been updated in line with the National Institute for Health and Care Excellence (NICE) guideline on Suspected cancer: recognition and referral (NICE 2023). The topic has undergone minor restructuring to improve clarity and navigation. The Prescribing information section has been expanded in line with current Prodigy style. Information on possible neurological adverse effects of cefalexin added in line with updated SPC.

Minor Changes:

Acne vulgaris — minor update. The formatting of the prescribing section has been updated to conform to the structure of other topics.
Allergic rhinitis — minor update. Cetirizine doses for people with renal impairment updated in line with manufacturer’s SPC.
Angina — minor update. Adverse effect of lupus-like syndrome added and also non-cardiogenic pulmonary oedema in overdose for people prescribed diltiazem in line with an update to the manufacturer’s SPC.
Anticoagulation – oral — minor update. Added information regarding the risk of coadministration of oral steroids with fluoroquinolones.
Asthma — minor update. Recommendations relating to COVID-19 infection have been removed from this topic. Information about the onset of action of beta-2 agonists aligned to SPC.
Atrial fibrillation — minor update. Changes to the order of wording for warfarin and DOACs in the anticoagulants section. Adverse effect of lupus-like syndrome added and also non-cardiogenic pulmonary oedema in overdose for people prescribed diltiazem in line with an update to the manufacturer’s SPC.
Bipolar disorder — minor update. A typographical error has been corrected. Information about the availability of MHRA safety and educational materials to reduce the risk of harm from valproate has been added to this topic.
Boils, carbuncles and staphylococcal carriage — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Bronchiectasis — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC). Recommendations relating to COVID-19 infection have been removed from this topic. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA MHRA, 2023.
Cardiac arrest – out of hospital care — minor update. Disparity in percentage of attempted bystander CPR rectified.
Cellulitis – acute — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Chest infections – adult — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Chlamydia – uncomplicated genital — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC). Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA.
Chronic kidney disease — minor update. Information that empagliflozin is an option for treating CKD has been added in line with the NICE Technology Appraisal [TA942]. Referral criteria revised to align with NICE Chronic kidney disease: assessment and management [NG203].
Chronic pain — minor update. Added additional information regarding duloxetine and dosing following the publication of a Cochrane review advising that doses of greater than 60 mg provided no additional benefit.
Constipation — minor update. Information that other medicines should not be taken orally for one hour before, during and for one hour after taking macrogol products has been added to this topic in line with the updated manufacturer’s SPC for Movicol.
Constipation in children — minor update. Information that other medicines should not be taken orally for one hour before, during and for one hour after taking macrogol products has been added to this topic in line with the updated manufacturer’s SPC for Movicol.
Contraception – Assessment — minor update. Levonorgestrel intrauterine systems (LNG-IUSs) are now referred to as levonorgestrel intrauterine devices (LNG-IUDs). The FSRH updated the terminology to align with other international organisations.
Contraception – IUC — minor update. Length of use of LNG-IUD revised to 8 years maximum for Mirena® in line with an update to the manufacturer’s summary of product characteristics.
COPD — minor update. Recommendations relating to COVID-19 infection have been removed from this topic. Information about the onset of action of beta-2 agonists aligned to SPC.
Corticosteroids – inhaled — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Corticosteroids – oral — minor update. Added information regarding the risk of coadministration of oral steroids with fluoroquinolones.
Cough – acute with chest signs in children — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC). Information about the onset of action of beta-2 agonists aligned to SPC.
COVID — minor update. Acute disseminated encephalomyelitis (ADEM) has been added as a possible adverse effect of Vaxzevria® vaccination in line with the updated SPC. The recommendation to consider benzodiazepine for managing anxiety or agitation, and the recommendations on medicines for end of life care have been removed from this topic in line with the updated NICE guideline COVID-19 rapid guideline: Managing COVID-19.
Cow’s milk allergy — minor update. Cetirizine doses for people with renal impairment updated in line with manufacturer’s SPC.
Crohn’s disease — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Delirium — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Dementia — minor update. Cautions for rivastigmine updated in line with manufacturer’s SPC.
Depression — minor update. An adverse effect of leukopenia relating to paroxetine has been added in line with an update to the manufacturer’s SPC. Revisions have been made to the Stopping antidepressants section following comments from an expert reviewer.
Diverticular disease — minor update. Information on possible neurological adverse effects of cefalexin added in line with updated SPC.
DMARDs — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Dyspepsia – proven peptic ulcer — minor update. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA MHRA, 2023.
Eczema – atopic — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC). Recommendations relating to COVID-19 infection have been removed from this topic.
Epilepsy — minor update. Replaced the quality statements to align with the new quality standard published by NICE Epilepsies in children, young people and adults Quality standard [QS211]. Information about the availability of MHRA safety and educational materials to reduce the risk of harm from valproate has been added to this topic.
Erectile dysfunction — minor update. Broken link removed.
Gallstones — Minor update. A link has been added to the NHS England Decision support tool: making a decision about gallstones.
Generalized anxiety disorder — minor update. An adverse effect of leukopenia relating to paroxetine has been added in line with an update to the manufacturer’s SPC.
Gonorrhoea — minor update. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA MHRA, 2023.
Heart failure – chronic — minor update. Typographical error in the summary corrected. Reference to furosemide SPC added.
Hypercholesterolaemia – familial — minor update. Recommendations on follow-up updated in line with the updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification.
Hypertension — minor update. Adverse effect of lupus-like syndrome added and also non-cardiogenic pulmonary oedema in overdose for people prescribed diltiazem in line with an update to the manufacturer’s SPC.
Incontinence – urinary, in women — minor update. Added information relating to a licensed dose of desmopressin medication for women with troublesome nocturia and urgency incontinence.
Insomnia — minor update. A recommendation to consider offering daridorexant for people with chronic insomnia has been added in line with the NICE technology appraisal Daridorexant for treating long-term insomnia.
Itch – widespread — minor update. Cetirizine doses for people with renal impairment updated in line with manufacturer’s SPC.
Leg ulcer – venous — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Lipid modification – CVD prevention — minor update. Recommendations updated in line with the NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification, including a new recommendation on the target lipid level for secondary prevention of CVD in people taking lipid-lowering treatment.
Malaria — minor update. Prognosis section updated in line with the UKHSA, 2024 publication Guidelines for malaria prevention in travellers from the UK.
Malaria – prophylaxis — minor update. Prognosis section updated in line with the UKHSA, 2024 publication Guidelines for malaria prevention in travellers from the UK.
Mastitis and breast abscess — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Measles — minor update. Information on the time window for post-exposure prophylaxis has been added in line with the updated UK Health Security Agency (UKHSA) National measles guidelines.
Meibomian cyst (chalazion) — minor update. Minor restructuring and re-wording of the referral management section undertaken.
Menorrhagia (heavy menstrual bleeding) — minor update. A link has been added to the NHS England Decision support tool: making a decision about managing heavy periods.
Multiple sclerosis — minor update. Detail added on genetic risk following publication of a Nature article Elevated genetic risk for multiple sclerosis emerged in steppe pastoralist populations.
Nausea/vomiting in pregnancy — minor update. Adverse effects of domperidone updated in line with updated SPC.
Neuropathic pain — minor update. Added additional information regarding duloxetine and dosing following publication of a Cochrane review advising that doses of greater than 60 mg provided no additional benefit.
Neutropenic sepsis — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
OCD — minor update. An adverse effect of leukopenia relating to paroxetine has been added in line with an update to the manufacturer’s SPC.
Olecranon bursitis — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Palliative care – constipation — minor update. Information that other medicines should not be taken orally for one hour before, during and for one hour after taking macrogol products has been added to this topic in line with the updated manufacturer’s SPC for Movicol.
Palliative care – cough — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Palliative care – dyspnoea — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Palliative care – general issues — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Paronychia – acute — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Pelvic inflammatory disease — minor update. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA, 2023.
Polycystic Ovary Syndrome — minor update. Broken link fixed.
Postnatal care — minor update. Added NHS England guidance GP six to eight week maternal postnatal consultation to the new policies section.
Pre-patellar bursitis — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Prostatitis – acute — minor update. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA, 2023.
PTSD — minor update. An adverse effect of leukopenia relating to paroxetine has been added in line with an update to the manufacturer’s SPC.
Restless legs syndrome — minor update. Restless legs augmentation syndrome (earlier onset of symptoms in the evening/afternoon, increase in symptoms, and involvement of other extremities) added as very common adverse effect to pramipexole in line with the manufacturer’s summary of product characteristics.
Rosacea — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Sarcoidosis — minor update. A typographical error has been corrected.
Scabies — minor update. Clarification added on the management approach to people with possible resistant scabies.
Scrotal pain and swelling — minor update. A link has been added to the NHS England Decision support tool: making a decision about inguinal hernia.
Self Harm — minor update. Update to the text relating to assessment of suicide risk added.
Sepsis — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Shingles — minor update. Topic summary changed to advise that people aged over 60 years are now eligible for vaccination.
Skin cancers – recognition and referral — minor update. Updated quality statements to new 2024 standard.
Sore throat – acute — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Stroke and TIA — minor update. Further clarification made on the recommendation to avoid use of statins for secondary prevention in people with a history of intracerebral haemorrhage, as all people with stroke will be offered statins (unless contraindicated) in secondary care after a diagnosis.
Trigeminal neuralgia — minor update. Adverse effects and interactions for carbamazepine updated in line with manufacturer’s SPC.
Ulcerative colitis — minor update. Recommendations relating to COVID-19 infection have been removed from this topic.
Urethritis – male — minor update. Information on the use of fluoroquinolones and reporting adverse reactions was added in line with the Drug Safety Update published by the MHRA, 2023.
Urticaria — minor update. Cetirizine doses for people with renal impairment updated in line with manufacturer’s SPC.
UTI-children — minor update. Information on possible neurological adverse effects of cefalexin added in line with updated SPC.
Whitlow (staphylococcal and herpetic) — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).
Whooping cough — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer’s Summary of Product Characteristics (SPC).

New Topic:

Spondyloarthritis and psoriatic arthropathy — this is a new Prodigy topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Agilio: Diagnosis and Treatment Guidance’s DTG February 2024 Update