Practical clinical guidance for common conditions and symptoms

Covering over 370 clinical topics for use in primary care, Agilio: Diagnosis and Treatment Guidance supports confident decision-making at the point of care.

Referenced and linked to source evidence and covering over 1,200 clinical presentations or patient scenarios, this guidance helps healthcare professionals:

  • Reach a diagnosis
  • Prescribe safely
  • Offer safe and effective treatment options or referral for specialist care
  • Create local protocols and guidance

This resource is only available to customers outside of the UK.

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Clinical topics commissioned by National Institute for Health and Care Excellence (NICE) for use in the NHS

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Evidence-based and rigorous content development process

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Continually reviewed and updated, with new topics introduced regularly

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Easily accessible at the point of care

370 +

clinical topics

1,200 +

clinical presentations or patient scenarios

65 +

updates a year

Up to 10

new topics each year

Publication Updates

13 Sep
Agilio: Diagnosis and Treatment Guidance September 2022 Update

This update contains 1 new topic, 4 significant changes and 20 minor changes.

New Topic
• Integrated health and social care for people experiencing homelessness — this is a new Agilio topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Significant Changes
• Gonorrhoea — reviewed. A literature search was conducted in July 2022 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.
• Hypertension — reviewed. A literature search was conducted in July 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic is now fully in line with the National Institute for Health and Care Excellence (NICE) guideline Hypertension in adults: diagnosis and management and includes recommendations for adults with type 2 diabetes. As updates had already occurred to align with the NICE guideline, no major new changes to the recommendations have been made. Minor restructuring changes have been made.
• Melanoma — reviewed. A literature search was conducted in July 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Minor structural changes have been made to this topic, recommendations on non-melanoma lesions have been removed and the topic title has been changed to Melanoma. There have been no major changes to the recommendations.
• Multiple sclerosis — reviewed. Updated to align with NICE [NG220] Multiple sclerosis in adults: management. No major changes to recommendations have been made.

Minor Changes
• Glaucoma — minor update. Added a link to the NHS England Decision support tool.
• Urinary tract infection – children — minor update. This topic has been updated with the NICE quality standards covering Urinary tract infection in children and young people.
• Feverish children – risk assessment — minor update. This topic has been updated with the NICE quality standards covering Fever in under 5s.
• Feverish children – management — minor update. This topic has been updated with the NICE quality standards covering Fever in under 5s.
• Impetigo -– minor update. A minor typographical error has been corrected.
• Immunizations – seasonal influenza — minor update. The management section has been updated to align with the NHS immunisation programme 2022 to 2023.
• Dupuytren’s disease — minor update. Added NHS England Decision support tool link.
• Carpal tunnel syndrome — minor update. Added link to the NHS England Decision support tool.
• Osteoarthritis — minor update. Added link to NHS England Decision support tools.
• Atrial fibrillation — minor update. Added a link to the NHS England Decision support tool.
• Cataracts — minor update. Added a link to the NHS England Decision support tool.
• Macular degeneration – age related — minor update. Added link to NHS England Decision support tool.
• Bipolar disorder — minor update. Removed prothrombin time as an annual monitoring requirement for sodium valproate.
• Smoking cessation — minor update. Added information relating to the Allen Carr Easyway seminar programme. Added information about the lack of availability of varenicline until further notice.
• Post-traumatic stress disorder — minor update. Typographical error corrected.
• Immunizations – childhood — minor update. UK and international immunisation schedule comparison tool has been added to the ‘unknown immunization history’ sections.
• Lipid modification – CVD prevention — minor update. A recommendation to consider offering inclisiran has been added in line with the NICE technology appraisal Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia.
• Hypercholesteraemia – familial — minor update. Recommendations on offering inclisiran and bempedoic acid have been added in line with the NICE technology appraisals Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidemia and Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia.
• Neuropathic pain – drug treatment — minor update. Information that people taking pregabalin should be monitored for suicidal ideation and discontinuation considered in suspected cases has been added to this topic in line with the updated Summary of Product Characteristics.
• Diabetes – type 1 — minor update. Recommendations on blood pressure targets have been updated, and recommendations on providing advice about periodontitis have been added in line with the updated NICE guideline Type 1 diabetes in adults: diagnosis and management.

09 Aug
Agilio: Diagnosis and Treatment Guidance August 2022 Update

This update contains 1 new topic, 7 significant changes and 30 minor changes.

New Topic
• Covid-19 – this is a new Agilio topic. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The recommendations have been made in line with current evidence in the literature.

Significant Changes
• Conjunctivitis – infective – reviewed. A literature search was conducted in April 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.
• Corneal superficial injury – reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Updated literature has been incorporated to provide supporting evidence for the guidance. No major changes to the clinical recommendations have been made.
• Dental abscess – reviewed. A literature search was conducted in June 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. The topic has been updated. There have been no major changes to recommendations.
• Fibroids – reviewed. A literature search was conducted in June 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 updated in line with current evidence in the literature. An additional information section has been added to the Management section, which outlines specialist assessment and management options.
• Otitis media – chronic suppurative – reviewed. A literature search was conducted in July 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Supporting references have been added to the existing guidance, with no major changes made to the recommendations.
• Gout – reviewed. A literature search was conducted in June 2022 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 this topic and recommendations on management of acute gout and prevention of gout have been updated in line with national guidelines.
• Dyspepsia – pregnancy associated – reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. A red flag section has been added. Changes have been made to prescribing recommendations for acid-suppressing drugs in line with the 2021 guideline from the National Institute for Health and Care Excellence (NICE) on Antenatal care, and expert opinion in review articles, and due to the long-term suspension of ranitidine.

Minor Changes
• Diabetes – type 2 – minor update. A section has been added on providing periodontitis advice in line with the updated NICE guideline.
• Urinary tract infection (lower) – men – minor update. Some minor text changes were made to this topic in line with the Public Health England (PHE) guideline Diagnosis of urinary tract infections. Quick reference tool for primary care for consultation and local adaption, but no changes were made to recommendations, and a referral recommendation has been removed as the guideline has been withdrawn.
• Peripheral arterial disease – minor update. Reviewed and updated wording regarding ABPI measurement to ensure consistency with the Agilio topic leg ulcer – venous.
• Antiplatelet treatment – minor update. Added potential drug interaction for rosuvastatin the manufacturer advises that ticagrelor might affect renal excretion of rosuvastatin, increasing risk for rosuvastatin accumulation. The exact mechanism is not known, but in some cases, concomitant use led to renal function decrease, increased creatinine phosphokinase level and rhabdomyolysis.
• Palliative care – general issues – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
• Palliative care – cough – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
• Palliative care – dyspnoea – minor update. Added new NICE guideline reference in the advice relating to COVID-19.
• Restless leg syndrome – minor update. Added information in the management, basis for recommendation that some authors advise that alpha ligand therapy is preferred first line as result of the risk of augmentation when prescribing dopaminergic medication.
• Obesity – minor update. The recommendation from the NICE technology appraisal Liraglutide for managing overweight and obesity has been added to the management section of this topic.
• Dyspepsia – proven peptic ulcer – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
• Dyspepsia – unidentified cause – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
• GORD in children – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
• Dyspepsia – proven GORD – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
• Dyspepsia – proven functional – minor update. Severe cutaneous reactions have been added as a possible adverse effect of omeprazole in line with the updated Summary of Product Characteristics.
• Candida female genital – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Balanitis – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Nappy rash – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Fungal skin infection – foot – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Fungal skin infection – body and groin – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Fungal skin infection – scalp – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Pityriasis versicolor – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Seborrhoeic dermatitis – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Candida skin – minor update. Added drug interaction between clotrimazole and tacrolimus.
• Headache – tension type – minor update. A minor text change has been made to this topic.
• Lipid modification – CVD prevention – minor update. A recommendation to consider offering icosapent ethyl has been added in line with the NICE technology appraisal Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides.
• Neuropathic pain – drug treatment – minor update. Information that people taking gabapentin should be monitored for suicidal ideation and discontinuation considered in suspected cases has been added to this topic in line with the updated Summary of Product Characteristics.
• Epistaxis – minor update. Information that Naspetin® was recently reformulated and no longer contains arachis oil (peanut oil) has been added to this topic in line with the updated Summary of Product Characteristics.
• Boils, carbuncles, and staphylococcal carriage – minor update. Information that Naspetin® was recently reformulated and no longer contains arachis oil (peanut oil) has been added to this topic in line with the updated Summary of Product Characteristics.
• Malaria prophylaxis – minor update. Added information about potential cardiovascular risk of prescribing chloroquine with macrolide antibiotics.
• UTI – children – minor update. The section on diagnosis has been updated in line with the updated NICE guideline Urinary tract infection in under 16s: diagnosis and management.

12 Jul
Agilio: Diagnosis and Treatment Guidance July 2022 Update

This update contains 6 significant changes and 8 minor changes.

Significant Changes
• Conjunctivitis – allergic — reviewed. A literature search was conducted in April 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.
• Candida – skin — reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. No major changes to recommendations have been made.
• Headache – medication overuse — reviewed. A literature search was conducted in April 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 updated in line with current evidence in the literature. No major changes to the recommendations have been made.
• Compression stockings — reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Updated literature has been incorporated to provide supporting evidence for the guidance. No major changes to the clinical recommendations have been made.
• Scabies — reviewed. A literature search was conducted in April 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.
• Generalized anxiety disorder — reviewed. A literature search was conducted in May 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Some minor structural changes have been made to this topic, but there have been no major changes to the recommendations.

Minor Changes
• Gastroenteritis — minor update. Minor typographical error corrected and the information on clarithromycin interactions in the prescribing information section has been consolidated and updated.
• Corticosteroids – topical (skin), nose, and eyes — minor update. Additional information about the possibility of topical steroid withdrawal syndrome has been added to the Basis for recommendation section on withdrawal of topical corticosteroids in line with the updated Summary of Product Characteristics of some topical corticosteroid products.
• Depression — minor update. Telephone number for Samaritans has been updated.
• Anticoagulation – oral — minor update. A typographical error has been corrected.
• Chickenpox — minor update. A typographical error has been corrected.
• Diabetes – type 2— minor update. Adverse effect of increased risk of vitamin B12 deficiency associated with metformin added, based on a drug safety update from MHRA. Revised dosing of metformin modified release in renal impairment to align with standard metformin.
• Shingles — minor update. Added adverse effect relating to Shingrix from the manufacturer’s SPC of a small risk of Guillain-Barre.
• Urinary tract infection (lower) – men — minor update. The 2012 SIGN Guideline Management of suspected bacterial infection in adults has been replaced with a guideline which solely applies to women.”

14 Jun
AGILIO: DIAGNOSIS AND TREATMENT GUIDANCE June 2022 Update

This update contains 10 significant changes and 7 minor changes.

Significant Changes
• Benign paroxysmal positional vertigo – reviewed. A literature search was conducted in March 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.

• Breast screening – reviewed. A literature search was conducted in April 2022 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.

• Candida – oral – reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. No major changes to recommendations have been made.

• Croup – reviewed. A literature search was conducted in April 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.

• Eczema – atopic – reviewed. An updated literature review was conducted in February 2022 to identify evidence-based guidelines, UK policy statements, systematic reviews, meta-analysis studies, and key randomized controlled trials published since the last full revision of this topic. Updated literature has been incorporated to provide supporting evidence for the guidance. A prescribing information section for topical calcineurin inhibitors has been added. Minor changes to prescribing advice in line with updated manufacturer guidance, and current recommendations in the British National Formulary. No major changes to the clinical recommendations have been made.

• Headache – cluster – reviewed. A literature search was conducted in February 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 updated in line with current evidence in the literature. The section on Prescribing information has been expanded to include detailed information about sumatriptan and zolmitriptan preparations for acute treatment of cluster headache.

• Poisoning or overdose – reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic.

• Irritable bowel syndrome – reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recommendations on the diagnosis and management of irritable bowel syndrome have been updated in line with guidance from the National Institute for Health and Care Excellence and the British Society of Gastroenterology.

• Neck pain – non specific – reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews and key randomized controlled trials published since the last revision of the topic. Some minor changes have been made to recommendations in line with international clinical guidelines and published expert opinion.

• Tinnitus – reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

Minor Changes:
• Contraception – combined hormonal methods – minor update. Angioedema added as an adverse effect in line with revised manufacturer’s SPC.

• Diabetes – type 2 – minor update. Adverse effects and contraindications of metformin and SGLT-2 inhibitors updated in line with revised manufacturer’s SPCs.

• GORD in children – minor update. The recommendation to consider ranitidine was changed to H2 receptor antagonists due to the global withdrawal of ranitidine. The prescribing information relating to omeprazole dosing was revised to include an update from the BNF and to remove the advice that this is a special preparation, as there are oral suspensions available on prescription.

• Epilepsy – minor update. Relevant sections of this topic have been updated to align with the National Institute for Health and Care Excellence (NICE) guideline Epilepsies in children, young people and adults.

• Fibroids – minor update. The recommendation for annual review in asymptomatic women has been removed based on a pragmatic approach to follow up instead for women who are symptomatic.

• Insomnia – minor update. Removed reference to NICE key therapeutic topic as this has been withdrawn. Removed related adverse effects and updated these in line with the manufacturer’s summary of product characteristics.

• Vitamin D deficiency in adults – minor update. Broken link replaced for advice on vitamin D preparations for people on a halal or kosher diet.

10 May
AGILIO: DIAGNOSIS AND TREATMENT GUIDANCE May 2022 Update

This update contains 8 significant changes and 18 minor changes.

Significant Changes:
• Trigeminal neuralgia — reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Updated literature has been incorporated to provide supporting evidence for the guidance. Addition of a differential diagnosis section. Minor changes to prescribing advice in line with manufacturer’s guidance (SmPC for Tegretol). No major changes to the clinical recommendations have been made.

• Headache – assessment — reviewed. A literature search was conducted in February 2022 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 current available literature. The sections on Prognosis, Complications, and Differential diagnosis have been deleted, as content is included elsewhere in this topic or in other Clarity’s DTG topics. No major changes to the clinical recommendations have been made.

• Headache – tension-type — reviewed. A literature search was conducted in February 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 updated in line with current evidence in the literature. The section on QIPP – options for local implementation for nonsteroidal anti-inflammatory drugs (NSAIDs) has been deleted. The recommendations on management in primary care have been updated to include the option of physiotherapy, regular exercise, cognitive behavioural therapy, and/or relaxation techniques for some people.

• Aphthous ulcer — reviewed. A literature search was conducted in March 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.

• Venous eczema and lipodermatosclerosis — reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic.

• Adverse drug reactions — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. No major changes were made to the recommendations.

• Parvovirus B19 infection — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Post-herpetic neuralgia — reviewed. A literature search was conducted in March 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.

Minor Changes:
• Multiple myeloma — minor update. Aligned the parameters of levels of moderate hypercalcaemia with the Hypercalcaemia Clarity DTG topic.• Learning disabilities — minor update. New wording added and statement of educational needs has been replaced by education, health and care plan.
• Bronchiectasis — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Whooping cough — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Gonorrhoea — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Asthma — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Lyme disease — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Scarlet fever — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Prostatitis – chronic — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Urethritis – male — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Pelvic inflammatory disease — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Chlamydia – uncomplicated genital — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Cervical screening — minor update. The section on follow-up screening after hysterectomy has been updated to align with the Public Health England 2021 guidance in Colposcopic diagnosis, treatment and follow up.
• Depression – antenatal and postnatal — minor update. Telephone number for UKTIS has been updated.
• Antiplatelet treatment — minor update. Added adverse effect of bradyarrhythmia and AV block for people taking ticagrelor in line with revised manufacturer’s SPC.
• Neuropathic pain – drug treatment — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.
• Benzodiazepines and Z-drugs — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.
• Opioid dependence — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.

11 Apr
AGILIO: DIAGNOSIS AND TREATMENT GUIDANCE April 2022 Update

This update contains 7 significant changes, 20 minor changes and 1 new topic.

Significant Changes:
• Molloscum contagiosum – reviewed. A literature search was conducted in March 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. A section on Risk factors has been added to Background information.

• Breathlessness – reviewed. A literature search was conducted in February 2022 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 some structural changes, but there have been no major changes to the recommendations.

• Cough – acute with chest signs in children – reviewed. A literature search was conducted in February 2022 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.

• Haematospermia – reviewed. Literature searches were conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

• Breastfeeding problems – reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Changes have been made to the section on management of suspected ductal infection to reflect a lack of evidence of the role of bacteria and yeast and to support the judicious use of antimicrobials.

• Hiccups – reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

• Cervical cancer and HPV – reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A new section on Assessment has been added to the Diagnosis section.

Minor Changes:
• Insomnia – minor update. Link to Mental Health Foundation has been updated.

• Otitis externa – minor update. Cetraxal® (ciprofloxacin 2 mg/mL ear drops solution in a single-dose container) and Cetraxal plus® added to the topical preparations table. Cilodex® removed and generic combined preparation ciprofloxacin and dexamethasone added.

• Sciatica (lumbar radiculopathy) – minor update. The results of a systematic review to determine the accuracy of digital rectal examination (DRE) in people with suspected cauda equina syndrome have been added to the basis for recommendation in the section on diagnosis.

• Immunizations – childhood – minor update. Information that the severe combined immunodeficiency (SCID) screening result should be checked before giving BCG or rotavirus vaccines has been added to this topic in line with UK Health Security Agency (UKHSA) guideline The complete routine immunisation schedule February 2022. A recommendation that people who have not had their first dose of HPV vaccine by the time they are 15 years old should be offered two doses given at least 6 months apart has been added in line with the UK Health Security Agency letter Changing to a 2 dose NHS HPV vaccination schedule for eligible adolescents and adults starting the course after they turn 15 years old, including men who have sex with men (MSM).

• Colic – infantile – minor update. A link to a patient information leaflet has been removed from this topic.

• Otitis media – acute – minor update to incorporate new advice provided in NICE [NG91] Otitis media (acute): antimicrobial prescribing, March 2022. Added advice to follow up people and review treatment if symptoms do not improve within 7 days or worsen at any time. A further recommendation added for children and young people to prescribe ear drops containing an anaesthetic and an analgesic for up to 7 days if an immediate oral antibiotic prescription is not given, and there is no ear drum perforation or otorrhoea. A new prescribing section on phenazone and lidocaine drops, Otigo® has been added.

• Generalized anxiety disorder – minor update. Contraindication to pregabalin use in pregnancy unless the benefits to the mother outweigh the risks to the foetus in line with the manufacturers summary of product characteristics.

• Anticoagulation – oral – minor update. Recommendations on managing people who are undergoing dental treatment and taking DOAC anticoagulants have been added and recommendations on people taking warfarin have been updated in line with the NHS Education for Scotland guidance Management of dental patients taking anticoagulants or antiplatelet drugs.

• Hypertension – minor update to align with the update in NICE [NG136] Hypertension in adults: diagnosis and management. Acute respiratory toxicity has been added as a very rare adverse effect of hydrochlorothiazide in line with the updated manufacturer’s Summary of Product Characteristics.

• Menopause – minor update. Added detail to recommendation regarding progestogen regimes in non-hysterectomised women taking sequential HRT.

• Multiple myeloma – minor update. The basis of recommendation section in management of suspected myeloma has been updated to add evidence to the recommendation that a serum-free light chain assay should be arranged for people with suspected multiple myeloma.

• Hypercholesterolaemia – familial – minor update. Minor text changes have been made to clarify the recommendation to offer a lipid-lowering drug.

• Palliative care – general issues – minor update. Reference to Mari Curie in this topic has been updated to reflect a change in the charity’s name.

• Anaemia – B12 and folate deficiency – minor update. Update to the management of neurological complications added the recommendation to seek advice from a neurologist.

• Giant cell arthritis – minor update. Wegener’s granulomatosis is now known as granulomatosis with polyangiitis.

• Pulmonary embolism – minor update. A typographical error has been corrected.

• Neuropathic pain drug treatment – minor update. Information about the use of pregabalin in pregnancy has been updated in line with the manufacturer’s Summary of Product Characteristics.

• Neck pain – cervical radiculopathy – minor update. The section on red flags has been clarified and updated.

• Neck pain – non-specific – minor update. The section on red flags has been clarified and updated.

• Diabetes type 2 – minor update. Updated renal thresholds for prescribing empagliflozin in line with updated manufacturers summary of product characteristics.

New Topic:
• Rehabilitation after traumatic injury – new topic – this is a new Clarity’s DTG topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

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