Clarity’s DTG March 2022 Update

This update contains 6 significant changes, 21 minor changes and 1 new topic.

Significant Changes:

• Gingivitis and periodontitis — reviewed. A literature search was conducted in December 2021 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.
• Scrotal pain and swelling — reviewed. A literature search was conducted in December 2021 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 to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A prescribing information section has been added to the topic, to include antibiotic treatment options for suspected acute epididymo-orchitis if not managed by a specialist sexual health clinic.
• Prostate cancer — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
• Heart failure – chronic — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.
• Chickenpox — reviewed. A literature search was conducted in September 2021 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. Additional information on when to consider admission to hospital for pregnant women with chickenpox has been added in line with updated guidance from Public Health England (Guidance on the investigation, diagnosis and management of viral illness, or exposure to viral rash illness, in pregnancy).
• Cervical cancer and HPV — reviewed. A literature search was conducted in January 2022 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 to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A new section on Assessment has been added to the Diagnosis section.

Minor Changes:

• Male pattern hair loss (male androgenetic alopecia) — minor update. Information added that while some manufacturers’ patient information leaflets may advise against combination treatment with minoxidil and finasteride, that this combination may be used by specialists.
• Immunizations – childhood — minor update. Information that Gardasil®9 vaccine will replace Gardasil® vaccine from 2022 has been added to this topic. Information added about avoiding live vaccines for children up to 12 months after birth exposed to infliximab during pregnancy.
• Neuropathic pain – drug treatment — minor update. Parkinsonism added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.
• Generalized anxiety disorder — minor update. Parkinsonism added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.
• Opioid dependence — minor update. Information on awareness of signs and symptoms of overdose added in line with revised manufacturer’s SPC.
• Gonorrhoea — minor update. A hyperlink to a patient information leaflet was updated.
• Common cold — minor update. Removed mention of delta variant COVID-19 symptoms in the differential diagnosis section, as this has now been broadened to include other variants.
• Restless legs syndrome — minor update. Added information relating to monitoring people taking ropinirole for the possibility of mania as symptoms have been reported with or without the symptoms of impulse control disorders.
• Deep vein thrombosis — minor update. Information added on an potential adverse effect of enoxaparin, acute generalized exanthematous pustulosis.
• Pulmonary embolism — minor update. Information added on a potential adverse effect of enoxaparin, acute generalized exanthematous pustulosis.
• Hepatitis B — minor update. Added information about the hexavalent hepatitis B vaccine.
• Osteoarthritis — minor update. Removed wording relating to glucosamine status as an over the counter medication.
• Polycystic ovary syndrome — minor update. Removed the information about metformin being contraindicated in pregnancy. The manufacturer’s summary of product characteristics advises that metformin can be taken in pregnancy and the periconception phase if clinically needed.
• Diabetes type 2 — minor update. Added information relating to the use of SGLT-2 inhibitors as an adjunct to treatment for adults with type 2 diabetes and chronic heart failure, atherosclerotic cardiovascular disease based on the updated NICE guideline Type 2 diabetes in adults: management [NG28].
• Seborrhoeic dermatitis — minor update. Information that olive oil may act as a growth medium for Malassezia yeasts has been added.
• Amenorrhoea — minor update. A recommendation that the combined oral contraceptive (COC) pill is an option if amenorrhoea persists for more than 12 months to help manage the risk of osteoporosis has been removed from this topic in line with the Endocrine Society guideline Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline.
• Whooping cough — minor update. Links to key therapeutic topic guidance removed as service has been retired.
• Back pain – low (without radiculopathy) — minor update. Links to key therapeutic topic guidance removed as service has been retired.
• Boils, carbuncles, and staphylococcal carriage — minor update. Links to key therapeutic topic guidance removed as service has been retired.
• Depression — minor update. Links to key therapeutic topic guidance removed as service has been retired.
• Post-herpetic neuralgia — minor update. Links to key therapeutic topic guidance removed as service has been retired.

New Topic:

• Faecal incontinence in adults — this is a new Clarity’s DTG topic. The evidence base has been reviewed in detail and recommendations are clearly justified and transparently linked to the supporting evidence.