Agilio’s Diagnosis and Treatment Guidance February 2023 Update

This update contains 9 significant changes and 34 minor changes.

Significant Changes:

• Burns and scalds — reviewed. A literature search was conducted in November 2022 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.
• Colic — reviewed. A literature search was conducted in November 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 amended in line with current evidence. The diagnostic criteria for infantile colic have been updated in line with the Rome IV criteria for functional gastrointestinal disorders in infants and toddlers (2016).
• Dry eye disease (name changed from dry eye syndrome) — reviewed. A literature search was conducted in December 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomised controlled trials published since the last revision of the topic. The topic title has been changed from ‘Dry eye syndrome’ to ‘Dry eye disease’ in line with current terminology in the literature. The definition of dry eye disease has been updated in line with the international Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) publication TFOS DEWS II Definition and classification report (Craig 2017). No major changes to clinical recommendations have been made.
• Dyspepsia – unidentified cause – reviewed. A literature search was conducted in November 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.
• Lacerations — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.
• Leg cramps — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No major changes to clinical recommendations have been made.
  Polycythaemia/erythrocytosis – reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. Minor updates were applied to the topic structure and up-to-date literature was incorporated to provide supporting evidence for the guidance. The clinical definition of erythrocytosis was updated to reflect the current British Society for Haematology guidance. No further major changes to the clinical recommendations have been made.
• Vertigo — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No major changes have been made to recommendations.
  Vestibular neuronitis — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic.

Minor Changes:

• Allergic rhinitis — minor update. Removed the decongestant ephedrine 0.5% as these have been discontinued.
• Attention deficit hyperactivity disorder — minor update. Management in specialist settings updated to include the option of melatonin medication in use for children and young people with insomnia aged 6-17 with ADHD, where sleep hygiene measures have been insufficient.
  Cellulitis acute — minor update. Revised recommendation on prescribing antibiotics in people with cellulitis and lymphoedema to align with the British Lymphology Society and Lymphoedema Support Network guideline, 2022 Guidelines on the Management of Cellulitis in Lymphoedema.
• Constipation — minor update. Added information about avoiding concomitant use of macrogol and starch-based food thickeners in line with an update to the manufacturer’s SPC.
• Coronavirus – COVID 19 — minor update. Added new contraindication and adverse effect of the Janssen COVID-19 vaccine in line with an update to the manufacturer’s SPC.
• Dementia — minor update. Remove duplication of smoking as a risk factor in the summary and revised the wording in the assessment section relating to onset of vascular dementia.
• Dental abscess — minor update. The choice of antibiotic for dental abscess has been updated in line with the Faculty of Dental General Practice guideline Antimicrobial Prescribing in Dentistry.
• Dyspepsia – proven functional — Minor update. Interstitial nephritis added as an adverse effect of lansoprazole, in line with the manufacturer’s updated SPC.
• Dyspepsia – proven GORD — Minor update. Intrstitial nephritis added as an adverse effect of lansoprazole, in line with the manufacturer’s updated SPC.
• Dyspepsia – Proven peptic ulcer — Minor update. Interstitial nephritis added as an adverse effect of lansoprazole, in line with the manufacturer’s updated SPC.
• Ectopic pregnancy — minor update. Information on secondary care management of threatened miscarriage has been removed from this topic and added to the Prodigy topic on Miscarriage.
• Epistaxis (Nosebleeds) — minor update. Patient information leaflet link updated.
• Heart failure – chronic — minor update. Updated the NICE Quality standards in line with the update NICE Quality standard Chronic heart failure in adults [QS9].
• Herpes simplex – genital — minor update. Tubulointerstitial nephritis added as a potential adverse effect of valaciclovir in line with an update to the manufacturer’s summary of product characteristics.
• Herpes simplex – oral — minor update. Tubulointerstitial nephritis added as a potential adverse effect of valaciclovir in line with an update to the manufacturer’s summary of product characteristics.
• Influenza – seasonal — minor update. Information that the Department of Health and Social Care (DHSC) notifies GPs directly if the national surveillance scheme indicates that influenza is circulating in the community has been added to this topic.
• Itch in pregnancy — minor update. Added information relating to phenothiazine derivatives potentiating QT interval prolongation based on an updated manufacturer’s SPC.
• Lipid modification – CVD prevention — minor update. Information regarding rosuvastatin interactions added in line with the manufacturer’s updated SPC.
• Hypercholesterolaemia – familial — minor update. Immune-mediated necrotizing myopathy added as a possible adverse effect and ledipasvir/sofosbuvir added to list of possible drug interactions for atorvastatin in line with the manufacturer’s updated SPC.
• Mastitis and breast abscess — minor update. Recommendation on emptying the affected breast in lactating women has been removed to align with the Academy of Breastfeeding Medicine Clinical Protocol 36, The Mastitis Spectrum, 2022.
• Meniere’s disease — minor update. Added information relating to phenothiazine derivatives potentiating QT interval prolongation based on an updated manufacturer’s SPC.
• Miscarriage — minor update. Information on secondary care management of threatened miscarriage has been added to this topic in line with the NICE guideline Ectopic pregnancy and miscarriage: diagnosis and initial management.
• Neuropathic pain – drug treatment — minor update. Toxic epidermal necrolysis added as a possible adverse effect of pregabalin in line with the updated Summary of Product Characteristics.
• Palliative care – constipation — minor update. Added information about avoiding concomitant use of macrogol and starch-based food thickeners in line with an update to the manufacturer’s SPC.
• Palliative care – oral — minor update. Clarification added about the use of betamethasone tablets for ulcers.
  Polymyalgia rheumatica — minor update. Hyperlinks to a charity organization have been updated.
• Pre-conception – advice and management — minor update. Updated the Quality Standards in line with the update NICE Quality standard [QS109] Diabetes in pregnancy.
• Scarlet fever — minor update. Antibiotic recommendations updated in line with the UKHSA Group A streptococcus in children. Interim clinical guidance summary issued on December 16. Typographical error in prescribing section amended.
• Seborrhoeic dermatitis — minor update. Information relating to selenium sulfide shampoo has been removed from this topic as the product has been discontinued in the UK.
• Shingles — minor update. Tubulointerstitial nephritis added as a potential adverse effect of valaciclovir in line with an update to the manufacturer’s summary of product characteristics.
• Smoking cessation — minor update. Updated the quality standards in line with the publication of NICE, 2022 QS207 Tobacco: treating dependence.
• Sore throat — minor update. Antibiotic recommendations updated in line with the UKHSA Group A streptococcus in children. Interim clinical guidance summary issued on December 16. Antibiotic recommendations updated in line with the UKHSA Group A streptococcus in children. Interim clinical guidance summary issued on December 9.
• Type 1 diabetes — minor update. Added the quality standards from the updated NICE Diabetes in pregnancy Quality standard [QS109]. The section on managing foot problems has been updated in line with the NICE guideline Diabetic foot problems: prevention and management.
• Type 2 diabetes — minor update. Added the quality standards from the updated NICE Diabetes in pregnancy Quality standard [QS109]. The section on managing foot problems has been updated in line with the NICE guideline Diabetic foot problems: prevention and management.