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Agilio: Diagnosis and Treatment Guidance October 2023 Update

This update contains 8 significant changes and 11 minor changes.

Significant Changes: 

  • Bacterial vaginosis — reviewed. A literature search was conducted in July 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 core recommendations have been made, but the advice on screening for sexually transmitted infections and the use of intravaginal gels has been updated based on the manufacturers’ recommendations. There have been minor changes made to the structure of the topic.
  • Cardiac arrest – out of hospital care — reviewed. A literature search was conducted in August 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. There have been minor structural changes to the topic, with the addition of two scenarios, ‘Out of hospital post-resuscitation care’ and ‘Terminating resuscitation’. Vasopressor and antiarrhythmic paediatric dose recommendations have been added to the ‘Basis for Recommendation’ for the management of shockable and non-shockable rhythm sections. Minor changes to the recommendations have been updated in line with current guidance, including an update to the recommended lidocaine dose (from 1 mg/kg to 100 mg).
  • Chilblains — reviewed. A literature search was conducted in July 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.
  • Domestic abuse — reviewed. A literature search was conducted in July 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic name has been changed from ‘Domestic violence and abuse’ to ‘Domestic abuse’, and the content has been updated in line with current evidence in the literature. The topic has undergone minor restructuring to improve clarity and navigation.
  • Hyperhidrosis — reviewed. A literature search was conducted to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The management recommendations have been updated in line with the current literature.
  • Obsessive-compulsive disorder — reviewed. A literature search was conducted in August 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone minor restructuring. No major changes to the recommendations have been made.
  • Pulmonary embolism — reviewed. A literature search was conducted in August 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.
  • Urinary tract infection (lower) – men — reviewed. A literature search was conducted in August 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

Minor Changes:

  • Antiplatelet treatment — minor update. A reference to a study about the risks of antiplatelet therapy has been added to the basis for recommendation in the section on preventing dyspepsia. The wording relating to antiplatelets and atrial fibrillation has been revised.
  • Attention deficit hyperactivity disorder — minor update. Added new product availability of melatonin for treatment of insomnia in children and adolescents aged 6-17 years with attention deficit hyperactivity disorder (ADHD), where sleep hygiene measures have been insufficient.
  • Back pain – low (without radiculopathy) — minor update. Added information to the red flag section based on NICE guidance contained in [NG234] 2023 Spinal metastases and metastatic spinal cord compression.
  • Chronic obstructive pulmonary disease — minor update. Updated NICE quality statements to align with the publication of revised quality statements for COPD.
  • Coronavirus – COVID 19 — minor update. Additional information added about the potential adverse effect of myocarditis in line with the updated manufacturer’s Summary of Product Characteristics.
  • Diabetes – type 2 — minor update. Delayed gastric emptying has been added as a possible adverse effect of semaglutide in line with the manufacturer’s updated Summary of Product Characteristics. Revised threshold for prescribing dapagliflozin in chronic kidney disease to align with NICE TA775.
  • GORD in children — minor update. Information that use of omeprazole suspension in infants with GORD is unlicensed has been removed, as a licensed product is now available.
  • Mastitis and breast abscess — minor update. The dose of metronidazole recommended for recurrent mastitis updated to reflect the availability of 400mg dose.
  • Otitis media with effusion — minor update. Topic update to align with the NICE guideline Otitis media with effusion in the under 12s [NG233]. The need for referral for formal assessment including tympanometry and hearing tests in a child has been refined and revised. The section on screening has been deleted. The advice for parents and children has been expanded in line with advice from NICE.
  • Sciatica (lumbar radiculopathy) — minor update. New symptoms added to Red flag symptoms and signs to bring topic in line with NICE guidance in [NG234] Spinal metastases and metastatic spinal cord compression.
  • Sleep disorders – shift work and jet lag — minor update. Added new product availability of melatonin for short-term treatment of jet-lag.
  • Smoking cessation — minor update. Change of wording in pregnancy follow-up to align with wording elsewhere in the topic regarding definition of non-smoker.