Practical clinical guidance for common conditions and symptoms

Covering over 370 clinical topics for use in primary care, Clarity’s 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 Jul
Clarity’s Diagnosis and Treatment Guidance July 2021 Update

This update contains 7 significant changes and 9 minor changes.

Significant Changes:
• Vitamin D deficiency in adults — reviewed. A literature search was conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic title has been shortened to ‘Vitamin D deficiency in adults’. The recommendations have been updated in line with current evidence in the literature. The recommendation on who should take year-round vitamin D supplementation for the prevention of vitamin D deficiency has been amended, in line with Public Health England (PHE) guidance PHE, 2016 PHE, 2020. The section on Calcium and vitamin D combination products has been removed from the Prescribing information section to avoid repetition with text in the Management section.

• Vitamin D deficiency in children — reviewed. A literature search was conducted in February 2021 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 recommended dose for vitamin D supplementation for prevention of vitamin D deficiency has been amended in line with the Royal Osteoporosis Society (ROS) publication Vitamin D and bone health: a practical clinical guideline for patient management in children and young people ROS, 2018.

• Contraception – assessment — reviewed. A literature search was conducted in March 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The structure of the topic has been changed. No major changes to the recommendations have been made.

• Contraception – sterilization — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Whitlow (staphylococcal and herpetic) — reviewed. A literature search was conducted in March 2021 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.

• Anal fissure — reviewed. A literature search was conducted in March 2021 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.

• Greater trochanteric pain syndrome — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

Minor Changes:
• Coronavirus – COVID-19 — minor update. Storage details for Pfizer BioNtech vaccine has been updated in line with the revised Summary of Product Characteristics, prevalence data have been updated, information on arranging PCR tests and self-isolation has been updated, information about rare thromboembolic events after AstraZeneca COVID-19 vaccine, information about variants of concern, and details of signs and symptoms of the Delta variant have also been added. The section on the Public health response has been removed as well as the information on administering the Pfizer BioNtech vaccine.

• Prostate cancer — minor update. Links to Prostate Cancer UK patient resources updated.

• Irritable bowel syndrome — minor update. Adverse effects for linaclotide have been updated in line with the revised manufacturer’s SPC and a link to the Ovarian cancer topic has been added to the section on differential diagnosis.

• Urinary tract infection (lower) – women — minor update. A typographical error has been corrected.

• Polymyalgia rheumatica — minor update. Hyperlinks to a charity organization have been updated.

• Antenatal care – uncomplicated pregnancy — minor update. Information on the European Health Insurance Card (EHIC) has been replaced with information on the Global Health Insurance Card (GHIC).

• Diabetes – type 2 — minor update. Adverse effects of GLP-1 receptor agonists updated in line with revised manufacturer’s SPC.

• Shingles — minor update. Prescribing information for aciclovir has been clarified.

• Platelets – abnormal counts and cancer — minor update. Family history of cancer added to the assessment of people with thrombocytosis.

08 Jun
Clarity’s Diagnosis and Treatment Guidance June 2021 Update

This update contains 6 significant changes and 31 minor changes.

Significant Changes:
• Palliative care – oral — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Minor restructuring of the topic was undertaken and recommendations updated in line with new evidence and guidelines.

• Palliative care – secretions — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – nausea and vomiting — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – malignant skin ulcer — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative cancer care – pain — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Dementia — reviewed. A literature search was conducted in March 2021 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 this topic, but no major changes to clinical recommendations.

Minor Changes:
• Nausea/vomiting in pregnancy — minor update. Domperidone has been added as a second-line treatment option and prescribing information has been added.

• Lipid modification – CVD prevention — minor update. Rosuvastatin added as a drug interaction with gemfibrozil in line with the updated Summary of Product Characteristics.

• Conjunctivitis – infective — minor update. The recommendation that use of chloramphenicol eyes drops is contraindicated in children aged under 2 years has been added.

• Atrial fibrillation — minor update. The topic has been updated to align with the updated NICE guideline Atrial fibrillation: diagnosis and management and includes the recommendation to use the ORBIT bleeding risk assessment tool when considering starting anticoagulation in people with atrial fibrillation, and that a direct oral anticoagulant should be used first-line in people considered to be at risk of stroke.

• Cervical screening — minor update. Information that cervical dysplasia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Cervical cancer and HPV — minor update. Information that cervical dysplasia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Shingles — minor update. Information that herpes zoster is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Hepatitis B — minor update. Information that hepatitis B is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Glandular fever (infectious mononucleosis) — minor update. Information that mononucleosis-like illness is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Chest infections – adult — minor update. Information that community-acquired pneumonia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Platelets – abnormal counts and cancer — minor update. Information that thrombocytopenia lasting for over 4 weeks is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Seborrhoeic dermatitis — minor update. Information that seborrhoeic dermatitis/exanthema is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Psoriasis — minor update. Information that severe or atypical psoriasis is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Candida – oral — minor update. Information that unexplained oral candidiasis is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Diarrhoea – adult’s assessment — minor update. Information that unexplained chronic diarrhoea is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Chronic kidney disease — minor update. Information that unexplained chronic renal impairment is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• HIV infection and AIDs — minor update. Information on non-AIDS-defining indicator conditions and a recommendation to offer HIV screening to people with these conditions has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Immunizations – travel — minor update. Recommendations that Revaxis and Avaxim should be used with caution in people with phenylketonuria have been added to this topic in line with the manufacturers’ Summary of Product Characteristics.

• Hepatitis A — minor update. A recommendation that Avaxim should be used with caution in people with phenylketonuria has been added to this topic in line with the manufacturer’s Summary of Product Characteristics.

• Immunizations – childhood — minor update. A recommendation that Revaxis should be used with caution in people with phenylketonuria has been added to this topic in line with the manufacturer’s Summary of Product Characteristics.

• Appendicitis — minor update. A typographical error has been corrected.

• Diabetes – type 2 — minor update. Adverse effects of SGLT-2 inhibitors updated in line with revised manufacturer’s SPC.

• Cough — minor update. Links have been added within the section on management of sub-acute and chronic cough to the assessment and diagnosis sections.

• DMARDs — minor update. Clarification added on frequency of pneumococcal vaccination where a single pneumococcal vaccine is now recommended unless the person on DMARDs also has asplenic, splenic dysfunction or chronic renal disease.

• Contraception – emergency — minor update. A typographical error has been corrected.

• Hypothyroidism — minor update. Prescribing advice about patients who experience symptoms on switching between different levothyroxine products has been added to this topic in line with MHRA advice.

• Migraine — minor update. A recommendation that a discussion of the potential benefits and risks, and the importance of effective contraception for women and girls of childbearing potential when taking topiramate has been added to this topic in line with the updated NICE guideline Headaches in over 12s: diagnosis and management.

• Epilepsy — minor update. A recommendation to urgently refer women for specialist advice if they are taking antiepileptic drugs and planning to become pregnant has been added to this topic in line with the Medicines and Healthcare products Agency (MHRA) Drug Safety Update Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review.

• Uveitis — minor update. Endophthalmitis was added as a sight-threatening differential diagnosis.

• Asthma — minor update. A typographical error has been corrected.

• Chronic obstructive pulmonary disease — minor update. A typographical error has been corrected.

11 May
Clarity’s Diagnosis and Treatment Guidance May 2021 Update

This update contains 6 significant changes, 11 minor changes and 1 new topic.

Significant Changes:
• Palliative care – constipation — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – cough — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – dyspnoea — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – general issues — reviewed. A literature search was conducted in February 2021 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.

• Delirium — reviewed. Literature searches were conducted to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Immunizations – pneumococcal — reviewed. A literature search was conducted in March 2021 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 aligned with the Public Health England publication Immunisation against infectious disease — The Green Book Chapter 25: Pneumococcal, and some minor structural changes have been made.

Minor Changes:
• Anaemia – iron deficiency — minor update. Diagnostic level of ferritin level was changed from 15 micrograms/L to 30 micrograms/L. Clarification of wording on volume dilution in pregnancy. Symptoms clarified to outline that pre-existing cardiac conditions can result in worsening angina, tachycardia, or heart failure. Changes were made to the threshold for ferritin levels in chronic kidney disease and inflammatory conditions.

• Aphthous ulcer — minor update. A typographical error has been corrected.

• Hypertension – minor update. Title of topic has been changed from ‘Hypertension – not diabetic’ to ‘Hypertension’.

• Lipid modification – CVD prevention — minor update. The scope of the topic has been clarified.

• Psychosis and schizophrenia — minor update. Some additional information on monitoring antipsychotics has been added to this topic.

• Bipolar disorder — minor update. Some additional information on monitoring antipsychotics has been added to this topic.

• Anticoagulation – oral — minor update. Information about reducing the dose of apixaban in renal impairment has been clarified. Erythema multiforme has also been added as an adverse effect of apixaban.

• Molluscum contagiosum — minor update. Information that the use of podophyllotoxin in people with anogenital molluscum contagiosum is off-label has been added to this topic.

• Conjunctivitis – infective — minor update. Contraindications for chloramphenicol eye drops have been updated in line with revised manufacturer’s SPC.

• Angina — minor update. Adverse effects of nicorandil updated in line with revised manufacturer’s SPC.

• Diabetes – type 2 — minor update. Adverse effects of DPP-4 inhibitors updated in line with revised manufacturer’s SPC.

New Topic:
• Chronic pain – this is a new topic. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

13 Apr
Clarity’s Diagnosis and Treatment Guidance April 2021 Update

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

Significant Changes:

• Obstructive sleep apnoea – reviewed. A literature search was conducted in January 2021 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. No major changes to the recommendations have been made.

• Gilbert’s syndrome – reviewed. A literature search was conducted in February 2021 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, but the topic has been restructured.

• Immunization – childhood – reviewed. A literature search was conducted in January 2021 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.

• Chlamydia – uncomplicated genital – reviewed. A literature search was conducted in February 2021 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.

• Itch – widespread – reviewed. A literature search was conducted in December 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. In the Scenario on Management, the sections on management of itch of known and unknown cause have been merged to avoid repetition of text. The recommendations have been updated in line with current evidence in the literature. The recommendations on prescribing oral antihistamines have been amended to consider the use of non-sedating oral antihistamines first line unless there is a history of troublesome nocturnal itch. New sections on Cetirizine, Loratadine, and Fexofenadine have been added to the section on Prescribing information.

• Contraception – progestogen-only – reviewed. A literature search was conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Bruising – reviewed. A literature search was conducted in February 2021 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.

• Earwax – reviewed. A literature search was conducted in March 2021 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, but the topic has been restructured.

Minor Changes:

• Epilepsy – minor update. Adverse effects of antiepileptic drugs updated to contain information on severe liver damage in children.

• Coronavirus – COVID-19 – minor update. Information on the Moderna COVID-19 vaccine has been added to this topic, information relating to immunization in pregnancy has been updated, as well as prevalence data. A typographical error has also been corrected.

• Scrotal pain and swelling – minor update. A typographical error has been corrected.

• Eczema – atopic – minor update. Updated to align with Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing [NICE, 2021].

• Sinusitis – minor update. A link to a patient information leaflet has been removed from the topic.

• Insomnia – minor update. Information on the risks associated with melatonin have been clarified to align with the updated NICE Key therapeutic topic on Insomnia.

• HIV infection and AIDs – minor update. Recommendations on post-exposure prophylaxis have been updated in line with the British Association for Sexual Health and HIV (BASHH) UK Guideline for the use of HIV Post-Exposure Prophylaxis 2021.

• Pyelonephritis – acute – minor update. Information on signs and symptoms of acute pyelonephritis have been clarified.

• Immunizations – travel – minor update. Adverse effects of meningococcal meningitis vaccination updated in line with revised manufacturer’s SPC.

• Opioid dependence – minor update. Drug interactions for methadone updated in line with revised manufacturer’s SPC.

• Depression – minor update. Suicide/suicidal thoughts and aggression in patients during discontinuation of venlafaxine has been added in line with updated manufacturer’s SPC. A typographical error has also been corrected.

• Deep vein thrombosis – minor update. A typographical error has been corrected.

• Malaria prophylaxis – minor update. Suicidal behaviour and psychiatric disorders have been added to the adverse effects of chloroquine in line with updated manufacturer’s SPC.

• Contraception – emergency – minor update. The section on types of emergency contraception has been clarified. Links have been amended in the section on continuing or starting regular contraception.

• Contraception – IUS/IUD – minor update. The recommendations on switching from a progestogen-only implant to the levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (Cu-IUD) have been updated in line with the Faculty of Sexual and Reproductive Healthcare (FSRH) guideline Progestogen-only implant [FSRH, 2021].

New Topic:

• Platelets – abnormal counts and cancer – is a new topic. A literature search was conducted in January 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence base has been reviewed in detail and recommendations are clearly justified and transparently linked to the supporting evidence.

09 Mar
Clarity’s Diagnosis and Treatment Guidance March 2021 Update

This update contains 6 significant changes and 16 minor changes.

Significant Changes:
• Addison’s disease – reviewed. A literature search was conducted in November 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Immunizations – travel – reviewed. A literature search was conducted in January 2021 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.

• Insulin therapy in type 2 diabetes – reviewed. A literature search was conducted in November 2020 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 recommendations have been updated in line with current literature.

• Multiple myeloma – reviewed. A literature search was conducted in December 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. There are no major changes to recommendations.

• Contraception – emergency – reviewed. A literature search was conducted in January 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Contraception – IUS/IUD – reviewed. A literature search was conducted in January 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

Minor Changes:
• Immunizations – pneumococcal – minor update. Information relating to routine pneumococcal immunization in children has been removed and a link to the topic Immunizations – childhood added.

• Bipolar disorder – minor update. Photosensitivity added as an adverse effect of lamotrigine in line with updated manufacturer’s SPC.

• Depression – minor update. SSRI drug interactions updated in line with manufacturer’s SPC for sertraline.

• Sleep disorders – shift work and jet lag – minor update. Revised licensing status for melatonin. Melatonin is now licensed for short-term use for the treatment of jet lag.

• Generalized anxiety disorder – minor update. Sertraline drug interactions updated in line with revised manufacturer’s SPC.

• Coronavirus – COVID-19 – minor update. A new guide to planning access to end-of-life care medicines during a pandemic has been included.

• Urological cancers – recognition and referral – minor update. Minor change to align with house style.

• Skin cancers – recognition and referral – minor update. Minor change to align with house style.

• Gynaecological cancers – recognition and referral – minor update. Minor change to align with house style.

• Childhood cancers – recognition and referral – minor update. Minor change to align with house style.

• Haematological cancers – recognition and referral – minor update. Minor change to align with house style.

• Gastrointestinal tract (lower) cancers – recognition and referral – minor update. Minor change to align with house style.

• Gastrointestinal tract (upper) cancers – recognition and referral – minor update. Minor change to align with house style.

• Head and neck cancers – recognition and referral – minor update. Minor change to align with house style.

• Lung and pleural cancers – recognition and referral – minor update. Minor change to align with house style.

• Brain and central nervous system cancers – recognition and referral – minor update. Minor change to align with house style.

09 Feb
Clarity’s Diagnosis and Treatment Guidance February 2021 Update

This update contains 7 significant changes, 24 minor changes and 1 new topic.

Significant Changes:
• Mastitis and breast abscess – reviewed. A literature search was conducted 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.

• Jaundice in adults – reviewed. A literature search was conducted 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.

• Jaundice in the newborn – reviewed. A literature search was conducted 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.

• Squint in children – reviewed. A literature search was conducted in December 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last version of this topic. No major changes to clinical recommendations have been made.

• Diabetes type 2 – reviewed. A literature search was conducted in November 2020 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 recommendations have been updated in line with current literature. Information on the hyperglycaemic emergency complication of hyperosmolar hyperglycaemic state (HHS) has been added.

• Tennis elbow – reviewed. A literature search was conducted in November 2020 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, and a recommendation not to use corticosteroids routinely for treating tennis elbow has been added to this topic.

• Anticoagulation – oral. A literature search was conducted in 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. However, sections on monitoring people taking anticoagulants during the COVID-19 pandemic has been included, based on the Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic [MHRA, 2020].

Minor Changes:
• Immunizations – seasonal influenza – minor update. Information added to reflect the authorization of the use of the recombinant quadrivalent vaccine (QIVr) in the 2020/2021 immunization programme.

• Neuropathic pain – drug treatment – minor update. Severe respiratory depression added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.

• Generalized anxiety disorder – minor update. Severe respiratory depression added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.

• Sciatica (lumbar radiculopathy) – minor update. Recommendations on offering neuropathic drugs at follow-up, and advising people with sciatica when to seek follow-up have been clarified.

• Boils, carbuncles, and staphylococcal carriage – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Bronchiectasis – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Cellulitis – acute – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Chest infections – adult – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Chlamydia – uncomplicated genital – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Cough – acute with chest signs in children – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Eczema – atopic – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Lacerations – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Leg ulcer – venous – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Olecranon bursitis – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Paronychia – acute – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Rosacea – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Sore throat – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Whitlow (staphylococcal and herpetic) – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Whooping cough – minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update.

• Epilepsy – minor update. The safety profile of valproate in paediatrics has been updated in line with revised manufacturer’s SPC.

• Coronavirus – COVID-19 – minor update. Prevalence figures have been updated and information that a new more transmissible variant of COVID-19 emerged in December 2020 has been added to this topic, along with updated information on vaccine dose schedules.

• Contraception – combined hormonal methods – minor update. Recommendations on switching from the progestogen-only implant to combined hormonal contraception have been updated in line with the updated Faculty of Sexual and Reproductive Healthcare (FSRH) guideline Switching or starting methods of contraception.

• Hyperthyroidism – minor update. Hypersensitivity reactions added as an adverse effect of propylthiouracil in line with updated manufacturer’s SPC.

• Diverticular disease – minor update. The duration of antibiotic treatment for uncomplicated acute diverticulitis has been updated in line with the NICE guideline Diverticular disease: diagnosis and management.

New Topic:
• Mental health in students – this is a new CKS topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.