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Agilio: Diagnosis and Treatment Guidance September 2023 Update

This update contains 9 significant changes and 22 minor changes.

Significant Changes:

  • Attention deficit hyperactivity disorder — reviewed. A literature search was conducted in June 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. There have been no changes made to the recommendations.
  • Carbon monoxide poisoning — reviewed. A literature search was conducted in May 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. The clinical recommendations have been updated to reflect the latest guidelines, sections about potential differential diagnoses and managing self-harm have also been added.
  • Fungal skin infection – body and groin — 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 major changes to the recommendations have been made.
  • Infertility — reviewed. A literature search was conducted in May 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 clinical recommendations have been made, but the topic has been restructured.
  • Lyme disease — reviewed. A literature search was conducted in May 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. No major changes to the recommendations have been made. Additional information about differential diagnosis and persisting non-specific symptoms have been included.
  • Multimorbidity — reviewed. A literature search was conducted in May 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials conducted since the previous search. No major changes have been made to the recommendations.
  • Parkinson’s disease — 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 has been updated in line with current evidence in the literature. No major changes to the recommendations have been made.
  • Rubella — 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.
  • Tuberculosis — 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. The topic has been updated in line with the National Institute for Health and Care Excellence (NICE) guideline for Tuberculosis (2019), and other literature, including guidance from the World Health Organisation (WHO, 2022).

Minor Changes:

  • Anticoagulation – oral — minor update. Adverse effect of nephropathy added to rivaroxaban in line with an update to the manufacturer’s summary of product characteristics.
  • Antiplatelet treatment — minor update. Revised the wording in the Which antiplatelet treatment section. Removed detail on secondary care treatments. Basis for recommendation section also revised to align with these changes in the treatment section.
  • Asthma — minor update. Change to the management section to clarify that quadrupling inhaled corticosteroids in acute asthma is relevant only to the management of adults.
  • Balanitis — minor update. A typographical error was corrected.
  • Bipolar disorder — minor update. Contact details for the UK Drugs in Lactation Advisory Service have been updated.
  • Bites – human and animal — minor update. Content in Wound Management sections restructured. No changes were made to recommendations.
  • Contraception – progestogen-only methods — minor update. Information that skin discolouration is a possible adverse effect of medroxyprogesterone acetate injection has been added to the section on adverse effects.
  • Coronavirus – COVID-19 — minor update. Information that Spikevax vaccine is indicated for people aged 6 months and over has been added to this topic in line with the manufacturer’s updated Summary of Product Characteristics.
  • Cough — minor update. Links to two references have been updated.
  • 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.
  • Fungal nail infection — minor update. Information on hepatic monitoring has been clarified.
  • Gastrointestinal tract (lower) cancers – recognition and referral — minor update. Criteria for faecal testing and referral for suspected colorectal cancer updated in line with NICE guidance Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care.
  • Immunizations – pneumococcal — minor update. Information relating to use of the 15-valent pneumococcal conjugate vaccine (PCV15) has been incorporated into this topic in line with the updated UK Health Security Agency (UKHSA) publication Immunisation against infectious disease (The Green Book) Chapter 25: Pneumococcal.
  • Immunizations – travel — minor update. A minor typographical error has been corrected.
  • Impetigo — minor update. The recommendation that children and adults should stay away from school and other childcare facilities or work until lesions are healed, dry and crusted over or 48 hours after initiation of treatment with antibiotics has been updated to also include treatment with hydrogen peroxide cream.
  • Insect bites and stings — minor update. Minor typographical error corrected.
  • Irritable bowel syndrome — minor update. Enterosgel® added as a new product licensed for the over-the-counter treatment of people with irritable bowel syndrome and diarrhoea.
  • Neuropathic pain – drug treatment — minor update. Toxic epidermal necrolysis added as a possible adverse effect of gabapentin, as well as information added on withdrawal reactions in line with the updated manufacturers’ summary of product characteristics.
  • Non-alcoholic fatty liver disease (NAFLD) — minor update. A typographical error has been corrected.
  • Obesity — minor update. The 2023 additions and amendments from the NICE clinical guideline Obesity: identification, assessment and management [CG189] have been added to the management section of this topic.
  • Ovarian cancer — minor update. The information relating to talc as a risk factor for ovarian cancer has been clarified.
  • Sore throat – acute — minor update. Clarification on the use of rapid antigen testing in sore throat added. NICE do not recommend this test and instead advise the use of clinical risk scoring.