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Agilio’s DTG August 2022 Update

This update contains 1 new topic, 7 significant changes and 30 minor changes.

New Topic

  • Covid-19 – this is a new Agilio topic. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The recommendations have been made in line with current evidence in the literature.

Significant Changes

  • Conjunctivitis – infective – reviewed. A literature search was conducted in April 2022 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.
  • Corneal superficial injury – reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Updated literature has been incorporated to provide supporting evidence for the guidance. No major changes to the clinical recommendations have been made.
  • Dental abscess – reviewed. A literature search was conducted in June 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. The topic has been updated. There have been no major changes to recommendations.
  • Fibroids – reviewed. A literature search was conducted in June 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The recommendations have been updated in line with current evidence in the literature. An additional information section has been added to the Management section, which outlines specialist assessment and management options.
  • Otitis media – chronic suppurative – reviewed. A literature search was conducted in July 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Supporting references have been added to the existing guidance, with no major changes made to the recommendations.
  • Gout – reviewed. A literature search was conducted in June 2022 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 this topic and recommendations on management of acute gout and prevention of gout have been updated in line with national guidelines.
  • Dyspepsia – pregnancy associated – reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. A red flag section has been added. Changes have been made to prescribing recommendations for acid-suppressing drugs in line with the 2021 guideline from the National Institute for Health and Care Excellence (NICE) on Antenatal care, and expert opinion in review articles, and due to the long-term suspension of ranitidine.

Minor Changes

  • Diabetes – type 2 –  minor update. A section has been added on providing periodontitis advice in line with the updated NICE guideline.
  • Urinary tract infection (lower) – men – minor update. Some minor text changes were made to this topic in line with the Public Health England (PHE) guideline Diagnosis of urinary tract infections. Quick reference tool for primary care for consultation and local adaption, but no changes were made to recommendations, and a referral recommendation has been removed as the guideline has been withdrawn.
  • Peripheral arterial disease – minor update. Reviewed and updated wording regarding ABPI measurement to ensure consistency with the Agilio topic leg ulcer – venous.
  • Antiplatelet treatment – minor update. Added potential drug interaction for rosuvastatin the manufacturer advises that ticagrelor might affect renal excretion of rosuvastatin, increasing risk for rosuvastatin accumulation. The exact mechanism is not known, but in some cases, concomitant use led to renal function decrease, increased creatinine phosphokinase level and rhabdomyolysis.
  • Palliative care – general issues – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
  • Palliative care – cough – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
  • Palliative care – dyspnoea – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
  • Restless leg syndrome – minor update. Added information in the management, basis for recommendation that some authors advise that alpha ligand therapy is preferred first line as result of the risk of augmentation when prescribing dopaminergic medication.
  • Obesity – minor update. The recommendation from the NICE technology appraisal Liraglutide for managing overweight and obesity has been added to the management section of this topic.
  • Dyspepsia – proven peptic ulcer – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
  • Dyspepsia – unidentified cause – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
  • GORD in children – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
  • Dyspepsia – proven GORD – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
  • Dyspepsia – proven functional – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
  • Candida female genital – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Balanitis – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Nappy rash – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Fungal skin infection – foot – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Fungal skin infection – body and groin – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Fungal skin infection – scalp – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Pityriasis versicolor – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Seborrhoeic dermatitis – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Candida skin – minor update. Added drug interaction between clotrimazole and tacrolimus.
  • Headache – tension type – minor update. A minor text change has been made to this topic.
  • Lipid modification – CVD prevention – minor update. A recommendation to consider offering icosapent ethyl has been added in line with the NICE technology appraisal Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides.
  • Neuropathic pain – drug treatment – minor update. Information that people taking gabapentin should be monitored for suicidal ideation and discontinuation considered in suspected cases has been added to this topic in line with the updated Summary of Product Characteristics.
  • Epistaxis – minor update. Information that Naspetin® was recently reformulated and no longer contains arachis oil (peanut oil) has been added to this topic in line with the updated Summary of Product Characteristics.
  • Boils, carbuncles, and staphylococcal carriage – minor update. Information that Naspetin® was recently reformulated and no longer contains arachis oil (peanut oil) has been added to this topic in line with the updated Summary of Product Characteristics.
  • Malaria prophylaxis – minor update. Added information about potential cardiovascular risk of prescribing chloroquine with macrolide antibiotics.
  • UTI – children – minor update. The section on diagnosis has been updated in line with the updated NICE guideline Urinary tract infection in under 16s: diagnosis and management.