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Agilio Diagnosis and Treatment Guidance April 2023 Update

This update contains 3 significant changes, 15 minor changes and 1 new topic.

Significant Changes:

  • Erectile dysfunction — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. The topic has undergone minor restructuring to improve clarity and navigation. No major changes to clinical recommendations have been made. Detail about phosphodiesterase-5 (PDE-5) inhibitor dose escalation if initial treatment is ineffective or unsatisfactory has been added in the section on Follow-up.
  • Ménière’s disease — reviewed. A literature search was conducted in February 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 recommendations have been made.
  • Menorrhagia (heavy menstrual bleeding) — reviewed. The topic title has been changed from ‘Menorrhagia’ to ‘Menorrhagia (heavy menstrual bleeding)’. A literature search was conducted in January 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 to clinical recommendations have been made.

Minor Changes:

  • Acute kidney injury — minor update. The updated NICE quality standards have been added to this topic.
  • Atrial fibrillation— minor update. Adverse effects and contraindications and cautions for diltiazem have been updated in line with the updated manufacturer’s Summary of Product Characteristics (SPC) for Slozem capsules.
  • Bedwetting (enuresis) — minor update. Added information about the option to prescribe Demovo® for the treatment of primary enuresis in children over the age of 5.
  • Bites – human and animal — minor update. A minor formatting change has been made to the section on wound care.
  • Blepharitis — minor update. A minor typographical error has been corrected.
  • Chronic kidney disease— minor update. Recommendations on giving people with CKD information about their 5-year risk of needing renal replacement therapy measured using the 4-variable Kidney Failure Risk Equation, and referring people with a 5-year risk of greater than 5% have been added to this topic in line with the NICE guideline Chronic kidney disease: assessment and management.
  • Coronavirus – COVID-19 — minor update. Several uncommon adverse effects of the Vaxzevria and Comirnaty vaccines were added in line with the manufacturer’s SPC. Information that the Spikevax bivalent vaccine is now licensed for use in people aged over 6 years has been added to this topic in line with the updated manufacturer’s Summary of product characteristics.
  • Diabetes – type 1 — minor update. The quality standards have been updated in line with updated NICE Quality standard Type 1 diabetes in adults [QS208].
  • Diabetes – type 2 — minor update. Updated quality statements in line with the publication of NICE Diabetes type 2 Quality Standard [QS209]. Added recommendation to consider adding finerenone as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults in line with the NICE Technology Appraisal [TA877].
  • Hypertension — minor update. Adverse effects and contraindications and cautions for diltiazem have been updated in line with the updated manufacturer’s Summary of Product Characteristics (SPC) for Slozem capsules.
  • Obesity — minor update. The recommendation from the NICE technology appraisal Semaglutide for managing overweight and obesity [TA875] has been added to the management section of this topic.
  • Rosacea — minor update. Information about alternative first-line antibiotic options have been added to this topic in line with The British Association of Dermatologists guidelines for the management of people with rosacea.
  • Scarlet fever — minor update. Antibiotic recommendations updated in line with the UKHSA guideline Scarlet fever: managing outbreaks in schools and nurseries. A prescribing section for azithromycin has been added and prescribing information for erythromycin has been combined with the section on clarithromycin.
  • Smoking cessation — minor update. Added information about the risk of bupropion unmasking Brugada syndrome in line with an update of the manufacturer’s SPC. Caution is advised in at risk patients.
  • Urinary tract infection (lower) – women — minor update. The recommendation to screen for asymptomatic bacteriuria in pregnant women has been removed to align with the NICE Guideline Urinary tract infection (lower): antimicrobial prescribing [NG109].

New Topic:

  • Pressure ulcers — new topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.