Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2020. This month there are four rapid guideline and evidence reviews and two evidence summaries related to COVID-19 that impact upon primary care.

The COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders guideline has been updated. The update highlights factors to take into account when considering temporarily stopping some drugs for children and young people.

The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been published and updated. It aims to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources. The update highlighted that immunosuppressant medicines should be reviewed if a patient may have COVID-19 or there are other medical concerns.

The COVID-19 rapid guideline: chronic kidney disease guideline has been published. It to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: interstitial lung disease guideline has been published. It aims to maximise the safety of adults with interstitial lung disease, including idiopathic pulmonary fibrosis and pulmonary sarcoidosis, during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19 evidence summary has been published. It aims to determine whether up regulation of angiotensin-converting enzyme 2, potentially as a result of taking ACEIs or ARBs, is associated with an increased risk of developing COVID-19 or developing more severe symptoms. This analysis found two observational studies that were of poor quality and subject to bias and confounding. As such conclusions cannot be drawn without further research.

The COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 evidence summary has been published. It aims to determine if long term use of NSAIDs is associated with an increased risk of developing COVID-19 or developing more severe symptoms. A literature search identified no evidence from published scientific studies. However, it is noted that NSAIDs and COVID-19 can both contribute to respiratory, cardiovascular and renal complications.

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

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Influenza medication guidance deactivated for 2019/20

The Department of Health and Social Care has issued a notification (PDF) advising that antivirals for influenza should no longer be prescribed this season.

The surveillance data from Public Health England (PHE) indicates that circulation of influenza in the community has returned to baseline levels. As such primary care clinicians should no longer prescribe antiviral medicines for the prophylaxis and treatment of influenza on an FP10 prescription form.

Action: Clinicians should be aware of this notification and cease prescribing antiviral drugs for the prevention and treatment of influenza.

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CKS Updates - April 2020

During April 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The scope of the Neuropathic pain - drug treatment has been updated to indicate that it does not cover sciatica.

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 - April 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of April 2020. This month there are seven rapid guideline and evidence reviews and one evidence summary related to COVID-19 that impact upon primary care.

The Acute use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 evidence summary has been published. This review found no evidence from published scientific studies to determine whether acute use of NSAIDs is related to increased risk of developing COVID-19 or increased risk of a more severe illness. It is noted that NSAIDs may either have no effect on, or worsen, long-term outcomes, possibly by masking symptoms of worsening acute respiratory tract infection. For now, paracetamol use to control fever symptoms would seem prudent in keeping with previous recommendations.

The COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD) guideline has been published. It aims to maximise the safety of patients with chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic, while protecting staff from infection. It will also enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community guideline has been published. It aims to provide recommendations for managing COVID‑19 symptoms for patients in the community, including at the end of life. It also includes recommendations about managing medicines for these patients, and protecting staff from infection.

The COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community guideline has been published. It aims to ensure the best treatment for adults with suspected or confirmed pneumonia in the community during the COVID-19 pandemic. It will also enable services to make the best use of NHS resources.

There are also COVID-19 rapid guidelines in the following areas that broadly apply to secondary care, but the recommendations to minimise face-to-face contact to reduce the risk of infection by using electronic means of communication, consultation and prescribing are pertinent to primary care as well.

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

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CKS Updates - March 2020

During March 2020 a further eleven Clinical Knowledge Summaries were published or updated in the following areas. [Updated April 2, 2020 to correctly note that these topics are new and updated for March]

The Coronavirus - COVID 19 topic is new.

All of the remaining topics have been reviewed and undergone minor restructuring. The most significant changes are to the Giant cell arteritis topic which has been updated in line with British Society for Rheumatology guidelines. The Scarlet fever topic has a new risk factors section and advice on admission is now held in the management section. The Tiredness/fatigue in adults topic has been updated in line with current evidence and the red flags are now detailed in the assessment section. The Undescended testes topic has been updated in line with current evidence and possible differential diagnoses are now contained in the diagnosis section.

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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