Agilio: Diagnosis and Treatment Guidance

11th March 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 5 significant changes, 30 minor changes and 1 new topic.

Significant Changes: 

• Chest infections – adult — reviewed. A literature search was conducted in December 2024 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.
• Deep vein thrombosis — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No changes to clinical recommendations have been made.
• Hypertension in pregnancy — reviewed. A literature search was conducted in November 2024 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 minor structural changes to the topic. A minor correction was made to the figures quoted relating to prognosis in future pregnancies. Given that there is no strong evidence that ACE inhibitor or ARB use in the first trimester poses a teratogenic risk to the fetus, a recommendation was added to provide reassurance where inadvertent exposure has occurred. Recommendations were altered regarding culture and sensitivity testing for women with asymptomatic bacteriuria, to align the topic with the latest guidance from NHS England.
• Obesity — reviewed. A literature search was conducted in January 2025 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 updated in line with the National Institute for Health and Care Excellence (NICE) new guideline Overweight and obesity management.
• Restless leg — reviewed. A literature search was conducted in January 2025 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.

Minor Changes:

• ADHD — minor update. Added information regarding gambling-related harms as a potential issue to consider in adults with ADHD in line with the NICE guideline Gambling-related harms: identification, assessment and management.
• Alcohol – problem drinking — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Antenatal care — minor update. A recommendation to reassure people with a BMI over 25 kg/m2 planning to become pregnant or in the first 12 weeks of pregnancy that they do not need to take more than 400 micrograms of folic acid a day unless they have an increased risk of having a baby with a neural tube defect or other congenital malformation has been added to this topic in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
• Bipolar disorder — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025. Minor typographical error corrected.
• Boils — minor update. Duration of antibiotic treatment updated to 5–7 days.
• Chlamydia — minor update. Detail added that if necessary, test of cure in pregnant women should be deferred for at least 3 weeks after treatment is completed.
• COPD — minor update. Further detail added on which second line antibiotics to consider when prescribing for an acute exacerbation.
• Corticosteroids – oral — minor update. Revised physiological dose equivalent of prednisolone. Revised timescale of taper of oral steroids from initial course of three weeks to four weeks in line with NICE guideline Adrenal insufficiency: identification and management NICE, 2024.
• Depression — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Diarrhoea – antibiotics associated — minor update. The wording has been updated to clarify treatment options for subsequent C. difficile infection episodes after initial symptom resolution.
• Fungal skin infection – scalp — minor update. Information about selenium sulfide shampoo has been removed from this topic as it has been discontinued.
• Generalised anxiety disorder — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Heart failure – chronic — minor update. Intestinal angioedema been added as an adverse effect of candesartan in line with the manufacturer’s SPC.
• Homelessness — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Insect bites and stings — minor update. Minor typographical error corrected.
• Insomnia — minor update. Added information on the availability of a new drug option for the treatment of insomnia, Lunivia®.
• Mastitis and breast abscess — minor update. External reviewers comments on a range of issues relating to management and diagnosis of mastitis.
• Mental health in students — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Opioid dependence — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Parkinson’s disease — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Paronychia — minor update. Duration of antibiotic treatment updated to 5–7 days.
• Pre-conception advice and management — minor update. A recommendation to reassure people with a BMI over 25 kg/m2 planning to become pregnant or in the first 12 weeks of pregnancy that they do not need to take more than 400 micrograms of folic acid a day unless they have an increased risk of having a baby with a neural tube defect or other congenital malformation has been added to this topic in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
• Psychosis — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• PTSD — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Roundworm — minor update. Information on mebendazole has been updated in line with the British National Formulary.
• Self-harm — minor update. Added detail relating to the NICE guidance Gambling-related harms: identification, assessment and management NICE, 2025.
• Smoking cessation — minor update. Added information on the potential use of cytisinicline as a stop smoking intervention to align with the updated NICE guideline NG209 Tobacco: preventing uptake, promoting quitting and treating dependence
• Threadworm — minor update. The section on mebendazole has been updated in line with the Roundworm topic.
• Urinary tract infection (lower) – women — minor update. Revised wording on nitrofurantoin in pregnancy to ensure consistency between prescribing sections.
• Whitlow — minor update. Duration of antibiotic treatment updated to 5–7 days.

New Topic:

• Hypokalaemia — this is a new Prodigy topic. A literature review was performed in September 2024. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

11th February 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 7 significant changes, 10 minor changes and 1 new topic.

Significant Changes:

• Asthma — reviewed. A literature search was conducted in December 2024 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 joint BTS/NICE/SIGN guideline Asthma: diagnosis, monitoring and chronic asthma management NG245 BTS/NICE/SIGN, 2024 and the Global Initiative for Asthma (GINA) guideline Global strategy for asthma management and prevention GINA, 2024. The recommendations on diagnosis and management of asthma in all age-groups have been updated in line with the BTS/NICE/SIGN (2024) recommendations, including use of different objective tests to confirm the diagnosis depending on age-group, and prescribing initial treatment with anti-inflammatory reliever (AIR) therapy or maintenance and reliever therapy (MART) using an inhaled corticosteroid (ICS)/formoterol combination inhaler for people aged 12 years and over first-line, and to consider a MART regime with an ICS/formoterol combination inhaler for children aged 5 to 11 years (off-label indication in this age-group).
• Hyperthyroidism — reviewed. A literature search was conducted in December 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with the National Institute for Health and Care Excellence (NICE) clinical guideline Thyroid disease: assessment and management (2023) and other current evidence in the literature.
• Hypothyroidism — reviewed. A literature search was conducted in November 2024 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 undergone minor restructuring. The recommendations have been updated in line with the National Institute for Health and Care Excellence (NICE) clinical guideline Thyroid disease: assessment and managementand other current evidence.
• Incontinence – urinary, in women — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The following changes have been made, vibegron has been added as an option for treating the symptoms of overactive bladder if antimuscarinic medicines are unsuitable, ineffective, or not tolerated, this is based on the National Institute for Health and Care Excellence (NICE) Technology appraisal guidance on Vibegron, and the topic has been restructured to improve navigation.
• Plantar fasciitis— reviewed. A literature search was conducted in November 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The recommendations on when to arrange additional imaging have been expanded. The basis for recommendation sections have been updated in line with current evidence in the literature.
• Renal or ureteric colic – acute— reviewed. A literature search was conducted in September 2024 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.
• Undescended testes — reviewed. A literature search was conducted from November to December 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recommendations have been updated in line with current evidence. Minor changes have been made with regards to referral in line with the latest NHS England guidance Newborn and infant physical examination (NIPE) screening programme handbook.

Minor Changes:

• Antenatal care – uncomplicated pregnancy — minor update. Information that pregnant women with a BMI over 30 kg/m2 should be advised to take a higher daily dose (5 mg of folic acid a day) has been removed from this topic, and sections on dietary advice, and exercise have also been updated in line with the updated NICE guideline Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years.
• Bipolar disorder — minor update. Severe cutaneous adverse reactions and hyperpigmentation added as adverse reactions for valproate, in line with the manufacturer’s updated SPC.
• Chronic obstructive pulmonary disease — minor update. A link was added to the NICE HTA Digital technologies to support self-management of COPD: early value assessment, to the text on self-management.
• HIV infection and AIDS — minor update. Wording change to the definition of advanced HIV disease.
• Immunizations – pneumococcal — minor update. Information relating to people aged over 10 years who are unvaccinated or partially vaccinated vaccination has been updated in line with the updated UK Health Security Agency (UKHSA) publication Immunisation against infectious disease (The Green Book) Chapter 25: Pneumococcal.
• Nausea/vomiting in pregnancy— minor update. The definition of hyperemesis gravidarum has been updated in line with RCOG, 2024 Guideline The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69). Information that growth differentiation factor 15 (GDF15) is a possible cause of hyperemesis gravidarum, and that hyperemesis gravidarum is associated with a higher risk of termination of pregnancy have also been added to this topic.
• Osteoporosis – prevention of fragility fractures — minor update. Information about the use of risedronate in people with severe renal impairment has been clarified.
• Palliative care – oral — minor update. A safety warning about the use of oral swabs with a foam head has been added to this topic.
• Sciatica (lumbar radiculopathy) — minor update. Information that sudden onset bilateral radicular pain or unilateral radicular pain progressing to bilateral pain is not by itself a feature of cauda equina syndrome (CES) but can be a warning that CES may occur, and that people with bilateral sciatica but without CES symptoms should be urgently referred to a musculoskeletal triage service has been added to this topic.
• Sickle cell disease — minor update. Information on which people with sickle cell crisis need immediate admission has been clarified.

New Topic:

• Cushing’s syndrome — new topic. A literature search was conducted in August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

10th December 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes, 15 minor changes and 1 new topic.

Significant changes:

• Bedwetting (enuresis) — reviewed and updated. A literature search was conducted in November 2024 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.
• Blepharitis — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.
• Hirsutism — reviewed and updated. A literature search was conducted in October 2024 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.
• Infectious mononucleosis (glandular fever) — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic title has been changed from Glandular fever (infectious mononucleosis) to Infectious mononucleosis (glandular fever), to reflect common terminology in the literature. The age cut-off below which to arrange Epstein-Barr virus (EBV) serology testing in children has been changed from 12 years to 4 years, in line with the Public Health England publication UK Standards for microbiology investigations. Epstein-Barr virus serology(PHE 2019). The information on treatments which are not recommended have been removed from the Management section.
• Psychosis and schizophrenia — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. There were no major changes to the recommendations.
• Raynaud’s phenomenon — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommended dose of sustained-release nifedipine for drug prophylaxis has been amended, in line with the consensus best practice pathway of the UK Scleroderma Study Group (2015). The prescribing information section has been updated and expanded, in line with current Prodigy style. No major changes to recommendations have been made.
• Trichomoniasis — reviewed. A literature search was conducted in September 2024 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 minor structural changes to the topic. Information on the risk factors, prognosis, and differential diagnosis have been added. There have been changes to the recommendation on the diagnosis of trichomoniasis to include information on sampling using nucleic acid amplification testing. There have been no major changes to recommendations on management.
• Styes (hordeola) — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to the recommendations have been made.

Minor updates:

• Cellulitis — minor update. A recommendation to advise people to use emollients to prevent dry and cracking skin has been added to the management section.
• Contraception – progestogen-only methods— minor update. Information that the depot medroxyprogesterone acetate (DMPA) intramuscular injection can be given every 13 weeks, but this dosing interval is off-label, has been added to the Summary, in line with the FSRH guideline Progestogen-only injectables. Information on follow-up for people taking drospirenone with mild/moderate renal insufficiency or with treated hypoaldosteronism has been added in line with the FSRH guideline Progestogen-only pills.
• Constipation — minor update. Information that naldemedine is an option for people with opioid-induced constipation has been added in line with the NICE technology appraisal Naldemedine for treating opioid-induced constipation.
• Diabetes – type 2— minor update.  Added information regarding the need for further evaluation of black people with known or potential sickle cell trait and the interpretation of HbA1c results, which may underestimate past glycaemia.
• Endometriosis — minor update. The diagnosis section has been updated in line with the updated NICE guideline Endometriosis: diagnosis and management.
• Epilepsy — minor update. Clarification of use of copper intrauterine devices to be preferred for women of childbearing age receiving enzyme-inducing antiepileptic drugs.
• Immunizations – seasonal influenza — minor update. Minor typographical error corrected in the summary section.
• Menopause— minor update. Updated to reflect the new guidance in NICE Menopause: identification and management [NG23], November 2024. Specifically relating to the risk and benefits of HRT.
• Menorrhagia (heavy menstrual bleeding) — minor update. The drug interactions section for tranexamic acid has been updated.
• Migraine— minor update. Wording update to information regarding atogepant to align with NICE technology appraisal.
• Osteoporosis – prevention of fragility fractures — minor update. Recommendations from the updated National Osteoporosis Guideline Group (NOGG) Clinical guideline for the prevention and treatment of osteoporosishave been incorporated into this topic.
• Palliative care – constipation — minor update. Information that naldemedine is an option for people with opioid-induced constipation has been added in line with the NICE technology appraisal Naldemedine for treating opioid-induced constipation.
• Seborrhoeic dermatitis — minor update. Revised advice on the potency of topical steroids to use when treating seborrhoeic dermatitis.
• Shingles — minor update. Added further link to management of people with shingles of the head and neck advising specialist management or admission to hospital.
• Urinary tract infection (lower) – women — minor update. Added information on MSU screening at booking appointments in intermediate and high-risk pregnancies to align with the NHS England document Saving babies’ lives: version 3 A care bundle for reducing perinatal mortality.

New Topic:

• Functional neurological disorder — new topic. A literature search was conducted in August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

12th November 2024

Agilio: Diagnosis and Treatment Guidance

8th October 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 9 significant changes and 20 minor changes.

Significant Changes:

• Bipolar disorder — reviewed and updated. A literature search was conducted in July 2024 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.
• Cholesteatoma — reviewed. A literature search was conducted in July 2024 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 undergone minor restructuring, to improve clarity and navigation. No major changes to recommendations have been made.
• Healthcare-associated infections — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Hypercalcaemia — reviewed. A literature search was conducted in July 2024 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 definitions of severity have been slightly amended in line with current literature. This is a condition which usually involves referral to secondary care, and an attempt has been made to clarify recommendations for primary care clinicians based on or extrapolated from available guidelines and expert opinion.
• Leg ulcer – venous — reviewed. A literature search was conducted in July 2024 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 minor structural changes to align the topic with recommendations provided in updated literature sources.
• Neutropenic sepsis — reviewed. A literature search was conducted in June to August 2024 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 no major changes to the recommendations. Quality statements temporarily removed from this topic due to ongoing updates to NICE guidelines on sepsis, which underpin the quality statements.
• Roundworm — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.
• Scarlet fever — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Self-harm — reviewed. A literature search was conducted in July 2024 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 undergone restructuring. No major changes to the recommendations have been made.

Minor Changes:

• Addison’s disease — minor update. Information about the interpretation of cortisol levels from the NICE guideline Adrenal insufficiency: identification and management has been incorporated into the diagnosis section of this topic.
• Attention deficit hyperactivity disorder — minor update. Minor text changes have been made in the section on Definitions.
• Alopecia areata — minor update. Ritlecitinib added to the specialist management options for severe alopecia areata.
• Atrial fibrillation — minor update. Minor typographical error corrected in the QOF indicators section.
• Chlamydia – uncomplicated genital — minor update. Information on asymptomatic screening in people aged under 25 years has been updated in line with the National Chlamydia Screening Programme.
• Chronic kidney disease — minor update. A minor typographical error has been corrected.
• Common musculoskeletal presentations in children — minor update. The name of the topic changed to ‘common musculoskeletal presentations in children’ from ‘developmental rheumatology in children’.
• Corticosteroids – topical (skin), nose, and eyes — minor update. Information relating to the potency of topical corticosteroids has been updated to reflect the new MHRA potency labeling system for topical corticosteroids.
• CVD risk assessment and management — minor update. Recommendations on physical activity have been clarified.
• Epilepsy — minor update. A new section about contraceptive advice to give men with epilepsy has been added in line with the MHRA drug safety update Valproate use in men: as a precaution, men and their partners should use effective contraception.
• Hand, foot, and mouth disease — minor update. Typographical error was corrected.
• Immunizations – seasonal influenza — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
• Lipid modification – CVD prevention — minor update. Added recommendation on adding icosapent ethyl.
• Measles — minor update. Revised information on management and contacts to align with the NHS England guidance Measles guidance for primary, community care, emergency departments and hospital.
• Migraine — minor update. Revised wording on typical migraine symptoms.
• Polycythaemia/erythrocytosis — minor update. Revised advice on management of apparent erythrocytosis to advise that these people need no further investigations.
• Prostate cancer — minor update. Added AoMRC reference to the assessment table for PSA level.
• Seborrhoeic dermatitis — minor update. Information relating to the potency of topical corticosteroids has been updated to reflect the new MHRA potency labeling system for topical corticosteroids.
• Sepsis — minor update. Quality statements temporarily removed from this topic due to ongoing updates to NICE guidelines on sepsis, which underpin the quality statements.
• Shingles — minor update. Information about severely immunosuppressed individuals who received Zostavax prior to becoming immunosuppressed has been added in line with an update to the UKHSA Shingles vaccination guidance.

10th September 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 7 significant changes and 30 minor changes.

Significant Changes:

• Cerebral palsy — reviewed. A literature search was conducted in June 2024 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 no major changes to the recommendations.
• Cow’s milk protein allergy in children — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Gallstones — reviewed. A literature search was conducted in April 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.
• Hepatitis A — reviewed. A literature search was conducted in May 2024 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.
• Prostatitis – chronic — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
• Retinal detachment — reviewed. A literature search was conducted in July 2024 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, and the recommendations on the diagnosis, assessment and management of suspected retinal detachment have been updated to align with current evidence.
• Superficial vein thrombosis (superficial thrombophlebitis) — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature, including to consider arranging urgent duplex ultrasound scan if there is suspected superficial vein thrombosis of the lower limb. Minor structural changes have been made to improve clarity and navigation.

Minor Changes:     

• Anaemia – iron deficiency — minor update. The summary updated to include FIT testing referral criteria and to align with the management section on referral.
• Angio-oedema and anaphylaxis— minor update. Details of updated NICE quality standards have been added to this topic.
• Bites – human and animal — minor update. An adverse effect of co-amoxiclav has been added as per the manufacturer’s SPC.
• Bronchiectasis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Cellulitis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Chronic kidney disease — minor update. Examples of structural abnormalities, and other abnormalities due to tubular disorders have been added to the bullet point on markers of kidney damage in the section on Definition.
• Chronic obstructive pulmonary disease — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Contraception – combined hormonal methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
• Contraception – emergency— minor update. Removed information about IUS expiry after 6 years for Mirena® as this is licensed for 8 years of contraception.
• Contraception – IUC — minor update. Length of use of LNG-IUD revised to 8 years maximum for Levosert® in line with an update to the manufacturer’s summary of product characteristics.
• Contraception – progestogen-only methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
• Cough – acute with chest signs in children — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Diabetes – type 2— minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics. Information that HbA1c may be used to diagnose type 2 diabetes in children and young people has been added to this topic in line with the updated International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline.
• Epilepsy — minor update. Broken links updated to MHRA information on topiramate in pregnancy.
• Heart failure – chronic — minor update. Update in wording on monitoring eGFR and creatinine after starting or titrating of renin-angiotensin system antagonists.
• Hypothyroidism — minor update. Minor typographical error corrected.
• Immunizations – seasonal influenza — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
• Mastitis and breast abscess — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC. Added information about considering the use of cold compresses for retroareolar inflammation.
• Migraine — minor update. A typographical error has been corrected.
• Neuropathic pain – drug treatment— minor update. Removed information regarding capsaicin cream as it is currently unavailable.
• Obesity — minor update. Added information about endoscopic sleeve gastroplasty as an option for people who may be high risk for bariatric surgery, who decline bariatric surgery because of the associated risk, or where this procedure may prevent progression of obesity and associated comorbidities. Added information about tirzepatide (Mounjaro®) and risks of interaction with oral contraception in individuals who are overweight or obese.
• Otitis media – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Post-herpetic neuralgia — minor update. Removed capsaicin cream recommendation, as this is currently unavailable.
• Prostate cancer — minor update. Following communication from an expert reviewer the topic has been updated to include recent research specifically on the asymptomatic nature of the presentation of prostate cancer, mortality and ethincity, prognostic models, change of terminology from Gleason score to Grade Group, additional information about PSA testing in men over the age of 79, and refinements to the outline of the active surveillance approach and applicability to different Cambridge Prognostic Groups.
• Pyelonephritis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Restless legs syndrome — minor update. Adverse effects of pramipexole updated in line with updated manufacturer’s SPC.
• Scrotal pain and swelling — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Sepsis — minor update. A minor typographical error has been corrected.
• Sinusitis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Smoking cessation — minor update. Alopecia added as an adverse effect of bupropion, in line with the manufacturer’s updated SPC.