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Agilio’s DTG October 2022 Update

This update contains 8 significant changes and 14 minor changes

Significant Changes:

  • Cervical screening — reviewed. A literature search was conducted in August 2022 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, but no major changes to clinical recommendations have been made.
  • Psoriasis — reviewed. A literature search was conducted in August 2022 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 undergone minor restructuring. The recommendations on the diagnosis and management of psoriasis have been amended in line with current evidence.
  • Knee pain – assessment — 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 the topic. Sections on causes of knee pain by anatomical site, specific knee tests and investigations have been added. No significant changes to the recommendations have been made.
  • Urticaria — reviewed. A literature search was conducted in August 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key controlled trials (RCTs) published since the last revision of the topic. No major changes to recommendations have been made.
  • Depression — 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 the topic. The recommendations have been updated in line with the updated National Institute for Health and Care Excellence (NICE) guideline Depression in adults: treatment and management (2022) and other evidence in the literature. The definitions of depression severity and options for treatment have been amended, in line with the NICE guideline. The topic has undergone minor restructuring to improve clarity and navigation.
  • Paronychia – acute — reviewed. A literature search was conducted in August 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. Prescribing information has been added for topical fusidic acid cream.
  • Malaria prophylaxis — review. 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 some minor structural changes to this topic, but no changes to recommendations.
  • Contraception – progestogen-only methods — reviewed. This topic has been reviewed to align with the updated Faculty of Sexual and Reproductive Health (FSRH) guideline Progestogen-only pills. Recommendations on starting drospirenone, switching to drospirenone from other methods of contraception, and managing missed pills have been incorporated as well as details of additional UKMEC considerations for drospirenone.

Minor Changes:

  • Contraception – assessment — minor update. A recommendation to check additional considerations before prescribing drosperinone, as well as the UK Medical Eligibility Criteria (UKMEC) that relates to all progestogen-only pills, has been added in line with the Faculty of Sexual and Reproductive Health (FSRH) Progestogen-only pills.
  • Contraception – Combined hormonal methods — minor update. Information on switching from the drosperinone progestogen-only pill to combined hormonal contraception has been added in line with the Faculty of Sexual and Reproductive Health (FSRH) guideline Progestogen-only pills.
  • Contraception – IUS/IUD — minor update. Recommendations on switching from the progestogen-only pill drosperinone to the levonorgestrel intrauterine system (LNG-IUS) have been added in line with the Faculty of Sexual and Reproductive Healthcare (FSRH) guideline Progestogen-only pills implant.
  • UTI – lower women — minor update. Broken links amended for RCGP patient leaflets. Revised and removed the recommendation on repeat sampling for women with asymptomatic bacteriuria based on the updated NICE [NG109] guideline UTI (lower) antimicrobial prescribing.
  • Diverticular disease — minor update. The dosage frequency of metronidazole when taken with trimethoprim has been amended.
  • Diabetes – type 2 — minor update. Recommendations on blood pressure targets have been updated in line with the updated NICE guideline Hypertension in adults: diagnosis and management [NG136].
  • Chest pain — minor update. Typographical error rectified.
  • Obesity — minor update. The sections on identification and classification, and general principles of care have been updated to align with the updated NICE guideline Obesity: identification, assessment and management.
  • Coronavirus – COVID-19 — minor update. Information that two bivalent booster vaccines (targeting the original strain and Omicron) are now available has been added to this topic.
  • Heart failure – chronic — minor update. Added information about the use of empagliflozin for treating chronic heart failure with reduced ejection fraction.  Added a prescribing section on managing SGLT-2 inhibitors.
  • Hepatitis B — minor update. Some information on prevalence has been removed from this topic.
  • Bipolar disorder — minor update. Valporate prescribing information updated based on SPC change.
  • Immunizations – seasonal influenza — minor update. The summary page has been updated.
  • Hepatitis C — minor update. A typographical error has been corrected.