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Agilio Diagnosis and Treatment Guidance March 2023 Update

This update contains 6 significant changes and 16 minor changes.

Significant Changes:

  • Bites – human and animal — revised. A literature search was conducted in January 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. Recommendations for assessment and management are largely based on the 2020 NICE guideline Human and animal bites: antimicrobial prescribing and the Public Health Wales guideline Health Protection Team Guidance for the Management of Human Bite Injuries in Wales (2019). As the topic had been updated to incorportate the 2020 NICE guidance since the last major review, no significant changes to recommendations have been made.
  • Pubic lice — reviewed. A literature search was conducted in December 2022 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.
  • Sore throat – acute — reviewed. A literature search was conducted in December 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. Recommendations were updated to align with the updated NICE guideline Sore throat (acute): antimicrobial prescribing.
  • Threadworm – February 2023 — reviewed. A literature search was conducted in December 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No major changes were made to the clinical recommendations.
  • Varicocele — reviewed. A literature search was conducted in December 2022 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.
  • Whooping cough — reviewed. A literature search was conducted in December 2022 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 recommendations have been made.

Minor Changes:

  • Antenatal care – uncomplicated pregnancy — minor update. The NICE Antenatal care quality standard has been updated.
  • Chickenpox — minor update. Added information on the infectious period of chicken pox to start at the time of rash to align with the UK Health Security Agency Guidelines on post exposure prophylaxis (PEP) for varicella or shingles (January 2023), based on a literature review by Marin et al Communicability of varicella before rash onset 2021.
  • Chronic kidney disease — minor update. The recommendation on management of people without diabetes and a urinary albumin:creatinine ratio (ACR) of less than 30 mg/mmol and associated hypertension has been clarified. Information that dapagliflozin is an option has been added in line with the NICE guideline Chronic kidney disease: assessment and management.
  • Contraception assessment — minor update. Added link to the Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability in the drug treatment section.
  • Coronavirus – COVID-19 — minor update. The section on available vaccines has been updated with details of new bivalent vaccines.
  • CVD risk assessment and management — minor update. The information that aspirin is not recommended for the primary prevention of cardiovascular disease (CVD) has been reworded to align with the updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification, which recommends that it should not be routinely offered for primary prevention of CVD.
  • Diabetes – type 2 — minor update. A link has been added from the prescribing section on SGLT-2 inhibitors to the section on Diabetic kidney disease and more information about prescribing dapagliflozin in chronic kidney disease has been added.
  • Domestic violence and abuse — minor update. The word ‘woman’ in the section on recognizing domestic violence and abuse has been replaced with ‘person’.
  • Epilepsy — minor update. Added further information about valproate in pregnancy and a link to the Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability in the Women of childbearing age scenario.
  • Generalised anxiety disorder — minor update. Added detail about prescribing paroxetine with caution in people with a (family) history of QT prolongation, concomitant use of anti-arrhythmics or other drugs prolonging QT interval, relevant pre-existing cardiac disease, and hypokalaemia or hypomagnesemia in line with an update to the manufacturer’s SPC.
  • Glaucoma — minor update. Additional information has been added to the section on adverse effects of topical dorzolamide to include hypertension and tachycardia in line with the manufacturer’s SPC.
  • Hepatitis B — minor update. Added adverse effects of Infanrix hexavalent vaccine in line with an update to the manufacturer’s SPC.
  • Hypertension — minor update. The recommendation on managing people with eGFR less than 60 mL/min/1.73 m² and/or the urinary ACR of 3 mg/mmol or more in the annual review section was clarified. Minor typographical error corrected in the diagnosis, basis of recommendation section.
  • Pyelonephritis — minor update. The NICE quality standards have been updated.
  • Urinary tract infection (lower) – men — minor update. The NICE quality standards have been updated.
  • Urinary tract infection (lower) – women — minor update. The NICE quality standards have been updated.