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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - February 2024

During February 2024 Clinical Knowledge Summaries were published or updated in the following areas.

The Adult malnutrition topic is new. The remaining topics have all been reviewed and updated with minor structural and layout changes. The Amenorrhoea topic has had the definitions of primary and secondary amenorrhoea have been amended to reflect expert opinion in guidelines. The DVT prevention for travellers topic has been updated to remove the moderate risk category in line with the latest guidelines. The Sepsis topic has been updated in line with NICE Guideline after it was updated in January.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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NICE Guidance - February 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2024. This month there is one guideline thats impacts upon primary care.

The Tuberculosis guideline has been updated. It covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. This update has removed family history of TB in the past 5 years from the list of criteria for BCG vaccination in neonates in low-incidence areas in line with national recommendations. It is also noted that antibiotic recommendations are being reviewed following the MHRA drug safety update regarding fluoroquinolone antibiotics.

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

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CKS Updates - January 2024

During January 2024 Clinical Knowledge Summaries were published or updated in the following areas.

The Spondyloarthritis and psoriatic arthropathy topic is new. The remaining topics have all been reviewed and updated with minor structural and layout changes. The Neck pain - whiplash injury topic has a new section section providing information on prevalence, causes and complications. The Sinusitis topic has updated the classification of chronic sinusitis in line with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). The Urinary tract infection (lower) - women topic has been updated in line with the UK Health Security Agency (UKHSA) quick reference tool for primary care for diagnosis and urinalysis and the management recommendations of UTI with haematuria have been updated in line with the NICE guideline on suspected cancer.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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NICE Guidance - January 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of January 2024. This month there are three guidelines that impact upon primary care.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers managing COVID-19 in babies, children, young people and adults in community and hospital settings. The update contains editorial changes and transferred the guideline from the MAGICapp platform to the NICE website.

The COVID-19 rapid guideline: managing the long-term effects of COVID-19 guideline has been updated. It covers covers identifying, assessing and managing the long-term effects of COVID-19, often described as 'long COVID'. The update contains presentation changes and transferred the guideline from the MAGICapp platform to the NICE website.

The Suspected sepsis: recognition, diagnosis and early management guideline has been updated. It covers the recognition, diagnosis and early management of suspected sepsis. The update makes new recommendations on risk evaluation and management of suspected sepsis for people aged 16 or over who are not and have not recently been pregnant, in mental health, ambulance and acute hospital settings.

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

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NICE Guidance - December 2023

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2023. This month there are three guidelines, two technology evaluations and two technology appraisals that impact upon primary care.

The Acne vulgaris: management guideline has been updated. It covers management of acne vulgaris in primary and specialist care. The update clarifies recommendations on oral isotretinoin treatment in line with the 2023 MHRA advice on the introduction of new safety measures.

The Digitally enabled therapies for adults with depression health technology assessment has been updated. Three digitally enabled therapies can be used as treatment options for adults with depression while further evidence is generated on their clinical and cost effectiveness. This update provide further information in the evidence generation plan.

The Digitally enabled therapies for adults with anxiety disorders health technology assessment has been updated. Six digitally enabled therapies can be used as treatment options for adults with anxiety disorders while further evidence is generated on their clinical and cost effectiveness. This update provide further information in the evidence generation plan.

The Cardiovascular disease: risk assessment and reduction, including lipid modification guideline has been published. It covers identifying and assessing risk of cardiovascular disease (CVD) in adults without established CVD and lifestyle changes and lipid-lowering treatment for primary and secondary prevention of CVD. It replaces previous guidance and contains a new recommendation on the target lipid level for secondary prevention of CVD.

The Empagliflozin for treating chronic kidney disease technology appraisal has been published. This treatment is recommended as an option for treating chronic kidney disease (CKD) in adults, only if:

  • it is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated, and
  • people have an estimated glomerular filtration rate of:
    • 20 ml/min/1.73 m2 to less than 45 ml/min/1.73 m2 or
    • 45 ml/min/1.73 m2 to 90 ml/min/1.73 m2 and either:
      • a urine albumin-to-creatinine ratio of 22.6 mg/mmol or more, or
      • type 2 diabetes.

The Targeted-release budesonide for treating primary IgA nephropathy technology appraisal has been published. This treatment is recommended as an option for treating primary immunoglobulin A nephropathy. This recommendation is contingent on a commercial agreement and as such it is expected prescribing would remain with a specialist.

The Bipolar disorder: assessment and management guideline has been updated. It covers recognising, assessing and treating bipolar disorder (formerly known as manic depression) in children, young people and adults. This update amends recommendations in line with the latest MHRA guidance on the use of valproate.

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

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