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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - July 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of July 2021. This month are two guidelines, four technology appraisals and one COVID-19 rapid guideline that impact upon primary care.

The Type 1 diabetes in adults: diagnosis and management guideline has been updated. It covers care and treatment for adults (aged 18 and over) with type 1 diabetes. It includes advice on diagnosis, education and support, blood glucose management, cardiovascular risk, and identifying and managing long-term complications. This updated amended the recommendations on long-acting insulin therapy.

The Clostridioides difficile infection: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for managing Clostridioides difficile infection in adults, young people and children aged 72 hours and over in community and hospital settings. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) guideline has been published. It covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a syndrome which has been reported in rare cases after COVID-19 vaccination. There is limited evidence available to inform clinical management, identification and management of the condition is evolving quickly as the case definition becomes clearer. This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome.

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

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CKS Updates - June 2021

During May 2021 Clinical Knowledge Summaries were updated in the following areas.

All topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Vitamin D deficiency in adults topic has updated the recommendation on who should take year-round vitamin D supplementation for the prevention of vitamin D deficiency, in line with PHE guidance. And the Vitamin D deficiency in children topic has changed the recommended dose for vitamin D supplementation for prevention of vitamin D deficiency in line with ROS guidance.

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 - June 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2021. This month are seven guidelines and one technology appraisal that impact upon primary care.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers the management of COVID-19 for children, young people and adults in all care settings. The update references publication via a global evidence platform.

The Atrial fibrillation: diagnosis and management guideline has been updated. It covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding. The update recommends using the ORBIT score to assess bleeding risk.

The Autism spectrum disorder in under 19s: support and management guideline has been updated. It covers the different ways that health and social care professionals can provide support, treatment and help for children and young people with autism, and their families and carers, from the early years through to their transition into young adult life. This updates adds new recommendations on interventions for feeding problems, including restricted diets.

The Autism spectrum disorder in adults: diagnosis and management guideline has been updated. It covers diagnosing and managing suspected or confirmed autism spectrum disorder in people aged 18 and over. It aims to improve access and engagement with interventions and services, and the experience of care, for people with autism. The update clarifies that a person who scores 6 or above on the AQ-10 should be offered a comprehensive assessment.

The Shared decision making guideline has been published. It covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

The Patient experience in adult NHS services guideline has been updated. It covers the components of a good patient experience. It aims to make sure that all adults using NHS services have the best possible experience of care. The update replaces several recommendations on share decision making and refers to the newly published guideline mentioned above.

The Acne vulgaris: management guideline has been published. It covers the management of acne vulgaris in primary and specialist care. It includes advice on topical and oral treatments (including antibiotics and retinoids), treatment using physical modalities, and the impact of acne vulgaris on mental health and wellbeing.

The Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis technology appraisal has been published. This treatment is recommended as an option for inducing remission of eosinophilic oesophagitis in adults. It is noted that since the appraisal process began the product license has been extended to include maintenance treatment but as no evidence was submitted for this newly licensed indication no recommendation is made at this time for maintenance.

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

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CKS Updates - May 2021

During May 2021 Clinical Knowledge Summaries were published or updated in the following areas.

All topics have been reviewed and updated in keeping with current guidance with minor layout changes. No major changes have been made within these topics.

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 - May 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2021. This month are three guidelines and one technology appraisal that impact upon primary care.

The Heavy menstrual bleeding: assessment and management guideline has been updated. It covers assessing and managing heavy menstrual bleeding (menorrhagia). It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, taking into account the woman's priorities and preferences. The update reinstated recommendations on the use of ulipristal acetate (Esmya®) for uterine fibroids in line with updated MHRA safety advice on the risk of serious liver injury.

The Epilepsies: diagnosis and management guideline has been updated. It covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. It offers best practice advice on managing epilepsy to improve health outcomes so that people with epilepsy can fully participate in daily life. The update reviewed and amended recommendations on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide in line with the MHRA updated safety advice on antiepileptic drugs in pregnancy.

The Headaches in over 12s: diagnosis and management guideline has been updated. It covers advice on the diagnosis and management of tension-type headache, migraine, cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. It aims to improve the recognition and management of headaches, with more targeted treatment to improve the quality of life for people with headaches, and to reduce unnecessary investigations. The update amended our recommendation on topiramate for migraine prophylaxis to include discussion of the potential benefits and risks, and the importance of effective contraception for women and girls of childbearing potential when taking topiramate.

The Crisaborole for treating mild to moderate atopic dermatitis in people 2 years and older technology appraisal has been terminated. This treatment is intended for use in the treatment of mild to moderate atopic dermatitis in people 2 years and older. However, the manufacturer withdrew its evidence submission and therefore no recommendation can be made at this time.

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

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