Agilio: Diagnosis and Treatment Guidance

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.

13th August 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes and 14 minor changes.

Significant Changes:

•Developmental rheumatology in children — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. A section on assessment has been added. Additional detail has been added in the management section for situations where GP reassurance and advice may be sufficient and no referral is necessary. Although there is no nationally agreed guidance for this area, the recommendations made have been linked to the supporting evidence, including local NHS referral guidance and expert opinion in review articles.
•Eating disorders — 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. No major changes to recommendations have been made.
•Endometriosis — A literature search was conducted in May 2024 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 is in line with the 2024 updated National Institute for Health and Care Excellence (NICE) guideline Endometriosis: diagnosis and management. No significant changes to recommendations for primary care have been made.
•GORD in children — 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. The recommendations have been updated in line with current evidence in the literature. The topic structure has been amended to improve clarity and navigation. A link to the First Steps Nutrition Trust resources has been provided, which gives information about infant formula milk requirements and different anti-reflux infant formula milk available.
•Lipid modification – CVD prevention — 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. The scope of the topic has been clarified, and prescribing information sections have been added for bempedoic acid, inclisiran, alirocumab, evolocumab, and icosapent ethyl. No major changes to clinical recommendations have been made.
•Migraine — 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 minor structural changes to the topic. Changes to the recommendations include an update regarding the topiramate pregnancy prevention programme in alignment with guidance from the Medicines and Healthcare products Regulatory Agency, the addition of candesartan or sodium valproate as alternative preventative treatment options (including the relevant restrictions regarding pregnancy/reproduction), and a recommendation to seek specialist advice about anti-emetic use in pregnant and breastfeeding women.
•Prostatitis – acute — 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 changes to the recommendations have been made.
•Shingles — 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.

Minor Changes:

•Asthma — minor update. Updated prevalence data and replaced broken links.
•Breathlessness — minor update. Added information from the NHS England Adult breathlessness pathway (pre-diagnosis): diagnostic pathway support tool relating to referral of people with uncertain cause of breathlessness.
•Chronic kidney disease — minor update. Minor formatting issue corrected. Minor change to the management of people with persistent proteinuria to revise a recommendation to titrate the dose of ARB or ACE inhibitor to the maximum tolerated dose.
•Corticosteroids – topical — minor update. New link to the SPS document Using inhaled and topical corticosteroids in breastfeeding added in the pregnancy and breastfeeding section.
•Eczema – atopic — minor update. Removed Calmurid cream as an option in emollients as this is no longer manufactured.
•Food allergy — minor update. A minor typographical error was corrected.
•Generalized anxiety disorder — minor update. Adverse effects of neuroleptic malignant syndrome (NMS) and stress cardiomyopathy relating to Duloxetine has been added in line with an update to the manufacturer’s SPC.
•Giant cell arteritis — minor update. Additional emphasis placed on the need to initiate glucocorticoids in primary care if GCA is ‘strongly suspected’ aligned with the British Society of Rheumatology guideline on diagnosis and treatment of giant cell arteritis wording.
•Immunizations – childhood — minor update. The use of MenQuadfi® has been added as an option for immunization against Meningococcal groups A, C, W and Y in line with the UKHSA updated guidance Meningococcal ACWY programme: information for healthcare professionals.
•Immunizations – seasonal influenza — minor update. The vaccines available and the age brackets in the vaccine choice section have been updated to reflect updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
•Impetigo — minor update. Prescribing section on hydrogen peroxide changed from 2% to 1% cream.
•Incontinence – urinary, in women — minor update. Adverse effects of neuroleptic malignant syndrome (NMS) and stress cardiomyopathy relating to Duloxetine has been added in line with an update to the manufacturer’s SPC.
•LUTS in men — minor update. Minor typographical error corrected in the prescribing section for furosemide.
•Whooping cough — minor update. Minor typographical error corrected in the prescribing section. Updated information on exclusion periods for cases and recommendations concerning the window of eligibility for antibiotics to align with the UKHSA national guidance on public health management of pertussis, June 2024.

9th July 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes and 12 minor changes.

Significant Changes:

• Atrial fibrillation — 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 this topic. The recommendations have been updated in line with current evidence in the literature. The topic structure has been amended to improve clarity and navigation. Information about the further assessment of device-detected atrial fibrillation (AF), including use of patient-initiated mobile or wearable devices has been added, in line with the European Society of Cardiology (ESC) joint guideline (2021). The management section has been split into two scenarios covering new-onset or acute AF, and the routine review of paroxysmal, persistent, or permanent AF.
• Autism in adults — 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 the topic. Minor structural changes have been applied to the topic, with the basis for recommendation sections updated to align with current guidance and evidence. The term, “People with autism” has been updated to “Autistic people” to align with changes in the NICE guidance from 2021.
• Contraception – combined hormonal methods — 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.
• Crohn’s disease — 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 the topic. Recent epidemiology figures have been added and detail added on the management of a flare-up of Crohn’s disease.
• CVD risk assessment and management — reviewed. A literature search was conducted in March 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor structural changes have been applied to the topic, with the basis for recommendation sections updated to align with current guidance from the National Institute for Health and Care Excellence (NICE) on Cardiovascular disease: risk assessment and reduction, including lipid modification and the European Society of Cardiology (ESC) guidelines on Cardiovascular disease prevention in clinical practice.
• End of life care in children — 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 the recommendations have been made, but the topic has been restructured.
• Opioid dependence — reviewed. A literature search was conducted in February 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 been updated and restructured with a focus on the generalist management of opioid dependency in primary care. Information on what to expect from specialist drug services following referral from primary care is included.
• Urethritis – male — 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 this topic. The topic has undergone minor restructuring with a section added on Assessment and Clinical features. No major changes to the recommendations have been made.

Minor Changes:

• Appendicitis — minor update. A typographical error has been corrected.
• Breast cancer – recognition and referral — minor update. Updated prevalence figures.
• Depression — minor update. An adverse effect of hypoglycaemia relating to venlafaxine has been added in line with an update to the manufacturer’s SPC.
• Dyspepsia – pregnancy-associated — minor update. Further revision of content in the regarding the specific use of antacids and alginates in pregnancy in the basis of recommendation section.
• Epilepsy — minor update. Information that topiramate is now contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled has been added to this topic in line with the MHRA drug safety update Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme.
• Erectile dysfunction — minor update. A typographical error has been corrected.
• Insomnia — minor update. Further clarification on wording regarding the use of Sleepio as recommended by NICE.
• Pelvic inflammatory disease — minor update. Information on adverse effects of moxifloxacin updated in line with manufacturer’s SPC.
• Prostate cancer — minor update. Meningioma added as an adverse effect of medroxyprogesterone acetate and caution is advised when prescribing medroxyprogesterone acetate to people with a history of meningioma, as per the manufacturer’s updated SPC.
• Post-traumatic stress disorder — minor update. An adverse effect of hypoglycaemia relating to venlafaxine has been added in line with an update to the manufacturer’s SPC.
• Scabies — minor update. Information that ivermectin 3 mg is unlicensed for treatment of scabies has been removed from this topic.
• Scrotal pain and swelling — minor update. The recommendation on management of people with suspected inguinal hernia who do not need emergency hospital admission has been clarified.

11th June 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 10 significant changes and 44 minor changes.

Significant Changes:

• Bowel screening — reviewed. A literature search was conducted in March 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. No major changes to clinical recommendations have been made.
• Chronic kidney disease — reviewed. A literature search was conducted in April 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Hearing loss in adults — reviewed. A literature search was conducted in March 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. The topic structure has been amended to improve clarity and navigation.
• Influenza – seasonal — 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.
• Meibomian cyst (chalazion) — reviewed. A literature search was conducted in March 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.
• MI – secondary prevention — reviewed. A literature search was conducted in March 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. The contraindications, cautions, adverse effects, and drug interactions of angiotensin-converting enzyme inhibitors and beta-blockers have been removed, and links have been added to relevant sections in the Agilio DTG topic on Hypertension.
• Peripheral arterial disease — reviewed. A literature search was conducted in March 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. There have been some minor structural changes to this topic, the term ‘critical limb ischaemia’ has been replaced with ‘chronic limb-threatening ischaemia’ in line with current literature terminology, but there have been no changes to the recommendations.
• Pilonidal sinus disease — reviewed. A literature search was conducted in February 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 clinical recommendations have been made, but the topic has been restructured.
• Sleep disorders – shift work and jet lag — reviewed. A literature search was conducted in March – April 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No significant changes to recommendations have been made. New sections have been added on risk factors and diagnosis.
• Urinary tract infection – children — reviewed. A literature search was conducted in March 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 to improve clarity and navigation.

Minor Changes:

• Abdominal aortic aneurysm screening — minor update. Changed information regarding NHS England who are now responsible for the screening programme.
• Balanitis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Benzodiazepine and z drug withdrawal — minor update. The suggested zopiclone withdrawal schedule has been updated.
• Boils, carbuncles, and staphylococcal carriage — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Bronchiectasis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Cellulitis — minor update. A typographical error has been corrected. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Cerebral palsy — minor update. Other drugs known to lower blood pressure added to the interactions section for baclofen in the prescribing section, in line with the manufacturers updated SPC for baclofen.
• Chest infections – adult — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Chronic obstructive pulmonary disease — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Cough – acute with chest signs in children — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Dental abscess — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Diabetes – type 2 — minor update. Recommendations on screening for, and management of, diabetic kidney disease have been removed from this topic and links added to the Prodigy topic on Chronic kidney disease.
• Dyspepsia – pregnancy associated — minor update. Revised content in the summary regarding the use of antacids and alginates following communication from UKTIS.
• Dyspepsia – proven functional — minor update. Doses of PPIs to use for H. pylori eradication have been clarified. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Dyspepsia – proven peptic ulcer — minor update. A table on PPI doses to use for eradication of H. pylori has been ended to this topic. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Dyspepsia – unidentified cause — minor update. Doses of PPIs to use for H. pylori eradication have been clarified. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Eczema – atopic — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Erectile dysfunction — minor update. Typographical error corrected.
• gastroenteritis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Heart failure – chronic — minor update. Revised wording on advice regarding fluid restriction to ensure that is focused on those people with severe symptomatic heart failure.
• Herpes simplex – genital — minor update. A typographical error has been corrected.
• Herpes simplex – oral — minor update. The dosage regimen for aciclovir has been aligned to the manufacturer’s summary of product characteristics.
• HIV infection and AIDS — minor update. A minor typographical error was corrected.
• Immunizations – seasonal influenza — minor update. The management section has been updated to align with the NHS immunisation programme 2024 to 2025.
• Impetigo — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Leg ulcer — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Mastitis and breast abscess — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Multiple sclerosis — minor update. Other drugs known to lower blood pressure added to the interactions section for Baclofen in prescribing information, in line with the manufacturer’s updated SPC.
• Nappy rash — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Olecranon bursitis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Otitis externa — minor update. A typographical error has been corrected.
• Otitis media – acute — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contraindicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC. Additional information added to the basis for recommendation in the section on management about use of anaesthetic and analgesic drops.
• Paronychia – acute — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Pre-patellar bursitis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated, as per the manufacturer’s updated SPC.
• Scarlet fever — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Sinusitis — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contraindicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Smoking cessation — minor update. Removed the information regarding the lack of provision of e-cigarettes from smoking cessation clinics.
• Sore throat – acute — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Temporomandibular disorders (TMDs) — minor update. This topic has been updated in line with the NHS England Getting It Right First Time (GIRFT) and Royal College of Surgeons’ Faculty of Dental Surgery guideline Management of painful temporomandibular disorder in adults.
• Urinary tract infection (lower) – men — minor update. Severe cutaneous adverse reactions (SCAR) added as an adverse effect of pivmecillinam, as per the manufacturer’s updated SPC.
• Warts – anogenital — minor update. The sections on assessment, and management have been updated in line with the British Association for Sexual Health and HIV (BASHH) national guideline for the management of anogenital warts in adults (2024).
• Whitlow (staphylococcal and herpetic) — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer’s updated SPC.
• Whooping cough — minor update. Added information regarding the tests available and the sources of each test for pertussis. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contra-indicated and caution is now advised when co-administering clarithromycin with edoxaban, in line with the manufacturer’s updated SPC. Additional detail has been added about the interaction between clarithromycin and tacrolimus.