Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - November 2019

During November 2019 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Depression in children topic has been updated in line with current NICE guidance. The Styes (hordeola) topic and the Teething topic have seen more significant layout changes and a new Assessment section has been added to the Styes (hordeola) topic.

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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Antiviral Medicines Authorised for Influenza Season 2019/20

The Department of Health has written to healthcare professionals via the Central Alerting System (PDF) to advise that antiviral medicines may now be prescribed at NHS expense due to rising levels in reporting of influenza-like illness.

Surveillance data indicates an increase in influenza cases in the community and as such GPs and other prescribers working in primary care may now prescribe antiviral medicines for the prophylaxis and treatment of influenza. NICE has issued guidance on the treatment and prevention of influenza with antiviral medication. A treatment algorithm and dose schedules are contained in Public Health England guidance.

Clinicians should remember to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay.

Action: Clinicians should be aware of this letter and familiarise themselves with the current prescribing guidance.

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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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CKS Updates - October 2019

During October 2019 Clinical Knowledge Summaries were published or updated in the following areas.

The Hearing loss in adults topic is new. The Halitosis topic has been updated in line with current evidence. The Shingles topic contains updated recommendations on antiviral treatment. It is recommended that antiviral treatment should be considered for all people aged over 50 years because while it has a low risk of complications, it does not significantly reduce the incidence of post-herpetic neuralgia. The other topics have undergone reviews and minor restructures.

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 - October 2019

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

The Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease technology appraisal has been published. Rivaroxaban plus aspirin is recommended within its marketing authorisation, as an option for preventing atherothrombotic events in adults with coronary artery disease or symptomatic peripheral artery disease who are at high risk of ischaemic events. For people with coronary artery disease, high risk of ischaemic events is defined as:

  • aged 65 or over, or
  • atherosclerosis in at least 2 vascular territories (such as coronary, cerebrovascular, or peripheral arteries), or
  • 2 or more of the following risk factors:
    • current smoking
    • diabetes
    • kidney dysfunction with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min (note that rivaroxaban is contraindicated if the eGFR is less than 15 ml/min)
    • heart failure
    • previous non-lacunar ischaemic stroke

The End of life care for adults: service delivery guideline has been published. It covers organising and delivering end of life care services, which provide care and support in the final weeks and months of life (or for some conditions, years), and the planning and preparation for this. It aims to ensure that people have access to the care that they want and need in all care settings. It also includes advice on services for carers.

The Diabetic foot problems guideline has been updated. It covers preventing and managing foot problems in children, young people and adults with diabetes. The update follows a review of the evidence for antimicrobial prescribing for diabetic foot infections.

The Gastro-oesophageal reflux disease and dyspepsia in adults guideline has been updated. It covers investigating and managing gastro-oesophageal reflux disease (GORD) and dyspepsia in people aged 18 and over. The update makes changes to recommendations on eradicating H pylori and updated footnotes in this guideline to reflect new restrictions and precautions for the use of fluoroquinolone antibiotics.

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. The update amended footnotes to reflect a change in the law relating to pregabalin and gabapentin now being classed as controlled drugs.

The Familial hypercholesterolaemia: identification and management guideline has been updated. It covers identifying and managing familial hypercholesterolaemia (FH), a specific type of high cholesterol that runs in the family, in children, young people and adults. The update changed the first recommendation on case finding and diagnosis to be clearer about when to suspect familial hypercholesterolaemia.

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

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