Agilio: Diagnosis and Treatment Guidance August 2023 Update

This update contains 8 significant changes and 40 minor changes.

Significant Changes:

Acute kidney injury — reviewed. A literature search was conducted in June 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 the current literature including updates to various Think Kidneys publications. There have been no major changes to recommendations.
Antiplatelet treatment — reviewed. A literature search was conducted in May 2023 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 restructured to reflect current guidance which does not recommend the routine use of antiplatelets for primary prevention. Minor changes to recommendations have been made in line with current UK and European guidelines.
Balanitis — reviewed. A literature search was conducted in May 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 the current literature. The recommendation to treat suspected severe bacterial infection has changed from flucloxacillin to phenoxymethylpenicillin, in line with the updated European consensus publication on balanoposthitis. The Prescribing Information section has been updated accordingly.
Diarrhoea – antibiotic associated — reviewed. A literature search was conducted in June 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Structural changes have been made to the topic. Recommendations on when to consider referral to secondary care have been added.
Food allergy — reviewed. A literature search was conducted in May 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No changes have been made to the recommendations.
NSAIDs prescribing issues — reviewed. A literature search was conducted in April 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. A recommendation to cautiously consider the use of low-dose celecoxib in people with risk factors for cardiovascular disease or the elderly has been added. Third-trimester pregnancy and varicella infection have been added as contraindications. Liver disease has been added as a risk factor for adverse renal effects, and advice to avoid prolonged NSAID use beyond 20 weeks of pregnancy has also been added.
Ovarian cancer — reviewed. A literature search was conducted in May 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.
Polycystic ovary syndrome — reviewed. A literature search was conducted in May 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. The recommendations on the use of metformin have been updated.

Minor Changes:

Alcohol – problem drinking — minor update. the NICE Quality Standard, Alcohol-use disorders: diagnosis and management has been updated.
Bites – human and animal — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Bronchiectasis — minor update. The summary of the manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Cellulitis – acute — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval. The summary of the manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Chest infections – adult — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Contraception – assessment — minor update. The information on excluding pregnancy has been updated to align with Faculty of Sexual and Reproductive Health guidelines.
Contraception – combined hormonal methods — minor update. The information on excluding pregnancy has been updated to align with Faculty of Sexual and Reproductive Health guidelines.
Contraception – progestogen only methods — minor update. The information on excluding pregnancy has been updated to align with Faculty of Sexual and Reproductive Health guidelines.
Dental abscess — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Depression — minor update. The quality standards have been updated in line with NICE guidance.
Diabetes – type 1 — minor update. Aligned the cardiovascular risk and monitoring for complications blood pressure information with a new link between these sections of the topic.
Diabetes – type 2 — minor update. Revised the dosing of canagliflozin dependent on eGFR in line with the manufacturer’s SPC.
Diverticular disease — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Dyspepsia – proven functional — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval. The summary of the manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Dyspepsia – proven GORD — minor update. Revised the potential post-operative mortality rate for Nissen fundoplication following publication of a systematic review and meta-analysis. A reference to the ACG clinical guideline: guidelines for the diagnosis and management of gastroesophageal reflux disease has been updated.
Dyspepsia – proven peptic ulcer — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Dyspepsia – unidentified cause — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval. The summary of the manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Gastroenteritis — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Gingivitis and periodontitis — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Healthcare-associated infections — minor update. The information regarding disposal of sharps boxes after 3 months, whether they are full or not, has been removed from this recommendation to align with an update to NICE guidance Healthcare-associated infections: prevention and control in primary and community care [CG139].
Heart failure – chronic — minor update. Information that dapagliflozin is recommended by NICE as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction has also been added to the prescribing information section.
Immunizations – travel — minor update. Added information regarding Avaxim Junior® and the appropriate dosing schedule for this immunization for the protection of children from hepatitis A.
Impetigo — minor update. A minor typographical error has been corrected. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Leg ulcer – venous — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Malaria — minor update. Proguanil is no longer available in the UK from 23rd July 2023.
Malaria prophylaxis — minor update. Removed proguanil as this has been discontinued in the UK.
Mastitis and breast abscess — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Non-alcoholic fatty liver disease (NAFLD) — minor update. A broken link to the FIB-4 calculator has been replaced.
Otitis media – acute — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Palliative care – malignant skin ulcer — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Palliative care – oral — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Paronychia – acute — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Pelvic inflammatory disease — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Scabies — minor update. A minor change to the method of applying permethrin cream has been added.
Scarlet fever — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Shingles — minor update. Information that the two-dose Shingrix® vaccine will be offered to all people as part of the shingles immunisation programme and that people aged over 60 years are now eligible for vaccination has been added to this topic in line with the UKHSA guidance Shingles vaccination: guidance for healthcare practitioners. Also the risk factor known as Wegener’s granulomatosis has now been changed to granulomatosis with polyangiitis.
Sinusitis — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Sore throat – acute — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).
Trichomoniasis — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Urethritis – male — minor update. The manufacturer’s SPC for metronidazole has been updated to note that QT prolongation has been reported (unknown frequency), particularly when metronidazole was administered with drugs with the potential for prolonging the QT interval.
Whooping cough — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).”