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

10 Jan
Agilio: Diagnosis and Treatment Guidance January 2023 Update

This update contains 2 minor changes.

Minor changes:
• Scarlet Fever – minor update. Antibiotic recommendations updated in line with the UKHSA Group A streptococcus in children. Interim clinical guidance summary.
• Sore Throat – minor update. Antibiotic recommendations updated in line with the UKHSA Group A streptococcus in children. Interim clinical guidance summary.

06 Dec
Agilio: Diagnosis and Treatment Guidance December 2022 Update

This update contains 7 significant changes, 11 minor changes and 1 new topic.

New Topic:
• Long-term effects of coronavirus (long COVID) — this is a new Agilio topic. A literature search was conducted in October 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:
• Alcohol – problem drinking — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes have been made to the recommendations.
• Back pain – low (without radiculopathy) — reviewed. A literature search was conducted in October 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 minor restructuring to improve clarity and navigation. The use of benzodiazepines for the management of muscle spasm associated with acute non-specific low back pain is no longer recommended, in line with the National Institute for Health and Care Excellence (NICE) guidance Low back pain and sciatica in over 16s: assessment and management (NICE 2020), which recommends the clinical and cost-effectiveness of benzodiazepines for the acute management of low back pain as an area for future research.
• Dyspepsia – proven GORD — reviewed. A literature search was conducted in October 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.
• Dyspepsia – proven peptic ulcer — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
• Pre-conception – advice and management — reviewed. A literature search was conducted in October 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No major changes were made to recommendations.
• Shoulder pain — reviewed. A literature search was conducted in October 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No major changes to recommendations have been made.
• Warts – anogenital — reviewed. A literature search was conducted in November 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. Minor updates to structure and updated literature has been incorporated to provide supporting evidence for the guidance. No major changes to the clinical recommendations have been made.

Minor Changes:
• Anticoagulation – oral — minor update. Added a rare adverse effect of rivaroxaban of eosinophilic pneumonia in line with the manufacturer’s SPC.
• Antiplatelet treatment — minor update. A new caution has been added when prescribing ticagrelor as the manufacturer advises caution relating to people with sleep apnoea.
• Attention deficit hyperactivity disorder — minor update. Management in specialist settings updated to include the option of melatonin medication in use for children and young people with insomnia aged 6-17 with ADHD, where sleep hygiene measures have been insufficient.
• Coronavirus – COVID-19 — minor update. Heavy menstrual bleeding added as a possible adverse effect of booster vaccinations in line with the updated manufacturer’s Summaries of Product Characteristics for Comirnaty and Spikevax vaccines. Recommendations on assessment and management of suspected long COVID have been removed from this topic and links added to the new Agilio topic on Long-term effects of coronavirus (long COVID).
• Diabetes – type 1 — minor update. Recommendations on continuous blood glucose monitoring have been updated in line with the NICE guidelines Type 1 diabetes in adults: diagnosis and management, and Diabetes (type 1 and type 2) in children and young people: diagnosis and management. The NICE quality standard for children and young people has also been updated.
• Diabetes – type 2 — minor update. Added delayed gastric emptying as an adverse effect of lixisenatide as per the manufacturer’s updated SPC.
• Heart failure – chronic — minor update. Added information about concomitant use of losartan and grapefruit juice to be avoided as grapefruit juice decreases the therapeutic effect of losartan.
• Hypercholesterolaemia – familial — minor update. Information regarding interactions between ticagrelor and rosuvastatin added in line with the manufacturer’s updated SPC.
• Lipid modification – CVD prevention — minor update. Information regarding interactions between ticagrelor and rosuvastatin added in line with the manufacturer’s updated SPC.
• Lyme disease — minor update. Information that doxycycline prescribing for children aged 9-12 is an off-label indication added to the prescribing section of this topic.
• Raynaud’s phenomenon — minor update. Added adverse effects of anxiety reactions, sleep disorders, mood changes, and depression based on an update to the manufacturer’s SPC.

08 Nov
Agilio’s Diagnosis and Treatment Guidance November 2022 Update

This update contains 5 significant changes and 10 minor changes.

Significant Changes:
• Measles — reviewed. A literature search was conducted in September-October 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. No major changes to recommendations have been made.
• Pruritis vulvae — reviewed. A literature search was conducted in September 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No significant changes to recommendations were made.
• Angio-oedema and anaphylaxis — reviewed. A literature search was conducted in September 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.
• Herpes simplex – genital — reviewed. A literature search was conducted in August 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The recommendations have been updated in line with current evidence. The topic has undergone minor restructuring to improve clarity and navigation. A Prescribing information section has been added for oral antiviral drugs that may be used for episodic or suppressive therapy in primary care.
• Dyspepsia – proven functional — reviewed. A literature search was conducted in September 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:
• Heart failure – chronic — minor update. Added information about the use of empagliflozin for treating chronic heart failure with reduced ejection fraction. Added a prescribing section on managing SGLT-2 inhibitors.
• Conjunctivitis – infective — minor update. Links to some references were updated.
• Attention deficit hyperactivity disorder — minor update. Adverse effects of dexamfetamine sulfate updated in line with manufacturer’s updated SPC.
• Lyme Disease — minor update. Information that tick-borne encephalitis was detected in a small number of ticks in Thetford Forest and an area on the border between Hampshire and Dorset in 2019 has been added to this topic.
• Angina — minor update. The text relating to contraindications and cautions for nitrates has been clarified.
• Glaucoma — minor update. Additional information has been added to the section on adverse effects of topical prostaglandin analogues and prostamides.
• Menopause — minor update. Information that exogenous oestrogens may induce or exacerbate symptoms of hereditary and acquired angioedema has been added to the adverse effects section of this topic.
• Bipolar disorder — minor update. Information about a drug interaction between lithium and dapagliflozin has been added to this topic.
• Osteoarthritis — minor update. The management recommendations have been updated in line the National Institute for Health and Care Excellence (NICE) clinical guideline Osteoarthritis in over 16s: diagnosis and management (2014). This includes advice on therapeutic exercise, offering pharmacological treatments alongside non-pharmacological treatments and at the lowest effective dose for the shortest possible time.
• Alcohol – problem drinking — minor update. Replaced a link in the prescribing section for acamprosate relating to monitoring.

11 Oct
Agilio’s Diagnosis and Treatment Guidance October 2022 Update

This update contains 8 significant changes and 14 minor changes

Significant Changes:
• Cervical screening — reviewed. A literature search was conducted in August 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 restructured, but no major changes to clinical recommendations have been made.
• Psoriasis — reviewed. A literature search was conducted in August 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 undergone minor restructuring. The recommendations on the diagnosis and management of psoriasis have been amended in line with current evidence.
• Knee pain – assessment — 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. Sections on causes of knee pain by anatomical site, specific knee tests and investigations have been added. No significant changes to the recommendations have been made.
• Urticaria — reviewed. A literature search was conducted in August 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key controlled trials (RCTs) published since the last revision of the topic. No major changes to recommendations have been made.
• Depression — 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. The recommendations have been updated in line with the updated National Institute for Health and Care Excellence (NICE) guideline Depression in adults: treatment and management (2022) and other evidence in the literature. The definitions of depression severity and options for treatment have been amended, in line with the NICE guideline. The topic has undergone minor restructuring to improve clarity and navigation.
• Paronychia – acute — reviewed. A literature search was conducted in August 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. Prescribing information has been added for topical fusidic acid cream.
• Malaria prophylaxis — review. 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 some minor structural changes to this topic, but no changes to recommendations.
• Contraception – progestogen-only methods — reviewed. This topic has been reviewed to align with the updated Faculty of Sexual and Reproductive Health (FSRH) guideline Progestogen-only pills. Recommendations on starting drospirenone, switching to drospirenone from other methods of contraception, and managing missed pills have been incorporated as well as details of additional UKMEC considerations for drospirenone.

Minor Changes:
• Contraception – assessment — minor update. A recommendation to check additional considerations before prescribing drosperinone, as well as the UK Medical Eligibility Criteria (UKMEC) that relates to all progestogen-only pills, has been added in line with the Faculty of Sexual and Reproductive Health (FSRH) Progestogen-only pills.
• Contraception – Combined hormonal methods — minor update. Information on switching from the drosperinone progestogen-only pill to combined hormonal contraception has been added in line with the Faculty of Sexual and Reproductive Health (FSRH) guideline Progestogen-only pills.
• Contraception – IUS/IUD — minor update. Recommendations on switching from the progestogen-only pill drosperinone to the levonorgestrel intrauterine system (LNG-IUS) have been added in line with the Faculty of Sexual and Reproductive Healthcare (FSRH) guideline Progestogen-only pills implant.
• UTI – lower women — minor update. Broken links amended for RCGP patient leaflets. Revised and removed the recommendation on repeat sampling for women with asymptomatic bacteriuria based on the updated NICE [NG109] guideline UTI (lower) antimicrobial prescribing.
• Diverticular disease — minor update. The dosage frequency of metronidazole when taken with trimethoprim has been amended.
• Diabetes – type 2 — minor update. Recommendations on blood pressure targets have been updated in line with the updated NICE guideline Hypertension in adults: diagnosis and management [NG136].
• Chest pain — minor update. Typographical error rectified.
• Obesity — minor update. The sections on identification and classification, and general principles of care have been updated to align with the updated NICE guideline Obesity: identification, assessment and management.
• Coronavirus – COVID-19 — minor update. Information that two bivalent booster vaccines (targeting the original strain and Omicron) are now available has been added to this topic.
• Heart failure – chronic — minor update. Added information about the use of empagliflozin for treating chronic heart failure with reduced ejection fraction. Added a prescribing section on managing SGLT-2 inhibitors.
• Hepatitis B — minor update. Some information on prevalence has been removed from this topic.
• Bipolar disorder — minor update. Valporate prescribing information updated based on SPC change.
• Immunizations – seasonal influenza — minor update. The summary page has been updated.
• Hepatitis C — minor update. A typographical error has been corrected.

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.

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