Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - November 2019

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2019. This month there are six guidelines and one technology appraisal that impact upon primary care.

The Fever in under 5s: assessment and initial management guideline has been published. It covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.

The Cannabis-based medicinal products guideline has been published. It covers the prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

The Thyroid disease: assessment and management guideline has been published. It covers investigating all suspected thyroid disease and managing primary thyroid disease (related to the thyroid rather than the pituitary gland). It does not cover managing thyroid cancer or thyroid disease in pregnancy. It aims to improve quality of life by making recommendations on diagnosis, treatment, long-term care and support.

The Diverticular disease: diagnosis and management guideline has been published. It covers the diagnosis and management of diverticular disease in people aged 18 years and over. It aims to improve diagnosis and care and help people get timely information and advice, including advice about symptoms and when to seek help.

The Familial breast cancer guideline has been updated. It covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. The update revised the recommendations on the topics that should be discussed with a person before making a decision on whether to have annual mammographic surveillance and includes links to patient decision aids.

The Multiple sclerosis in adults: management guideline has been updated. It covers diagnosing and managing multiple sclerosis in people aged 18 and over. This update replaced the recommendation on using Sativex (a THC:CBD spray) to treat spasticity in people with multiple sclerosis with a cross-reference to recommendations on THC:CBD spray in the NICE guideline on cannabis-based medicinal products.

The Pentosan polysulfate sodium for treating bladder pain syndrome technology appraisal has been published. The treatment is recommended as an option for treating bladder pain syndrome with glomerulations or Hunner's lesions in adults with urinary urgency and frequency, and moderate to severe pain, only if:

  • their condition has not responded to an adequate trial of standard oral treatments
  • it is not offered in combination with bladder instillations
  • any previous treatment with bladder instillations was not stopped because of lack of response
  • it is used in secondary care and
  • the company provides pentosan polysulfate sodium according to the commercial arrangement.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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