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Agilio: Diagnosis and Treatment Guidance’s DTG November 2023 Update

This update contains 5 significant changes, 11 minor changes and 1 new topic.

Significant Changes:

  • Diarrhoea – prevention and advice for travellers – 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. No major changes to the recommendations have been made.
  • Faltering Growth – 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. No changes to clinical recommendations have been made, but the topic has been restructured.
  • Neck pain – acute torticollis – reviewed. A literature search was conducted in September 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor structural changes have been made to the topic to align with up-to-date evidence. A short section detailing some complications which can arise in people with acute torticollis has been added.
  • Pelvic inflammatory disease — 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 recommendations have been updated in line with current evidence in the literature. The topic has undergone minor restructuring to improve clarity and navigation. A section on the antibiotic Levofloxacin has been added to the Prescribing information section.
  • Seborrhoeic dermatitis – reviewed. A literature search was conducted in September 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

Minor Changes:

  • Anticoagulant – oral – minor update. Adverse effect of nephropathy added to edoxaban in line with an update to the manufacturer’s summary of product characteristics.
  • Chickenpox – minor update. Revised information in the basis for recommendation on antiviral treatment post-exposure prophylaxis for all pregnant women to align with the UK Health Security Agency Guidelines on post exposure prophylaxis (PEP) for varicella/shingles.
  • Eczema – atopic – minor update. Added manufacturer’s SPC link to the erythromycin suspension prescribing section.
  • Endometriosis – minor update. Zalkya (dienogest) 2 mg added to the new product availability to treat endometriosis.
  • Gonorrhoea – minor update. Advice to reduce the dose of ceftriaxone in adults with severe renal impairment in combination with hepatic impairment, if the estimated glomerular filtration rate (eGFR) is less than 10 mL/minute/1.73 m2, has been amended to if creatinine clearance is less than 10 ml/min. This is in accordance with the advice outlined in the BNF.
  • Greater trochanteric pain syndrome – minor update. A typographical error has been corrected.
  • Heart failure – chronic – minor update. Some recommendations in the sections on management have been clarified.
  • neuropathic pain drug treatment – minor update. Revision to the information regarding use of creatinine clearance for dose adjustments for prescribing gabapentin and pregabalin in people with renal impairment.
  • Non-alcoholic fatty liver disease – minor update. A typographical error has been corrected.
  • Psoriasis – minor update. Information that aqeuous cream can be used as a soap substitute has been removed from this topic in line with updated advice from the National Eczema Society and withdrawal of the SPS article Using aqueous cream as a soap substitute for skin washing.
  • Stroke – minor update. The recommendation to avoid use of statins for secondary prevention in people with a history of intracerebral haemorrhage has been removed and information added to the basis to explain this change, based on a large trial which demonstrated no difference in adverse impact. The topic was also aligned with the recommendations contained in the updated NICE guideline [NG236] Stroke rehabilitation in adults October 2023.

New Topic:

  • Sarcoidosis – 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.