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Agilio: Diagnosis and Treatment Guidance August 2025 Update

This update contains 8 significant changes and 11 minor changes.

Significant Changes:

  • Coeliac disease — reviewed. A literature search was conducted in March 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to the recommendations have been made.
  • Diabetes – type 2 — reviewed. A literature search was conducted in April 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
  • Falls — reviewed. A literature search was conducted in April 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.
  • Immunizations – childhood — reviewed. A literature search was conducted in May 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been updated in line with the current national immunization guidance from the UK Health Security Agency. Specifically, details relating to eligibility for the influenza vaccine, changes to the vaccination schedule for Meningitis B and Pneumococcal vaccine, and the new 18 months appointment for those born on or after 1 July 2024 have been added to the topic. Details relating to the use of Haemophilus influenzae b and meningitis C (Hib/MenC) vaccine have been removed as production has been stopped, and the vaccine is expected to be unavailable from the middle of 2025. There have also been minor structural changes to the topic.
  • Immunizations – travel — reviewed. A literature search was conducted in July 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. A section on dengue and dengue vaccination was added to the topic. All other recommendations were updated in line with the latest guidance from the UK Health Security Agency (UKHSA) and the National Travel Health Network and Centre (NaTHNaC).
  • Insulin therapy in type 2 diabetes— reviewed. A literature search was conducted in May 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
  • Jaundice in adults — reviewed. A literature search was conducted in June 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The term non-alcoholic fatty liver disease (NAFLD) has been replaced with the term metabolic dysfunction-associated steatotic liver disease (MASLD) in line with international consensus. No major changes to the recommendations have been made.
  • Sprains and strains — reviewed. A literature search was conducted in March 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

 

Minor Changes:

  • Appendicitis — minor update. Updated information on prevalence of recurrence after non-surgical management and appendiceal carcinoma to the differential diagnosis.
  • Cellulitis — minor update. Minor typographical error corrected.
  • Constipation — minor update. Removed senna as an option for treatment for constipation in pregnancy due to a change in the manufacturer’s SPC.
  • CVD risk assessment and management — minor update. Quality statements updated in line with the updated NICE quality standard Cardiovascular risk assessment and lipid modification.
  • Earwax — minor update. Links to guidelines on ear irrigation, microsuction, and aural instrumentation have been added.
  • Endometriosis — minor update. Added information regarding the management of women with endometriosis who may still require combined HRT following hysterectomy.
  • Hyponatraemia — minor update. Added clarification on admission criteria.
  • Lipid modification – CVD prevention — minor update. Quality statements updated in line with the updated NICE quality standard Cardiovascular risk assessment and lipid modification.
  • Menopause — minor update. Added information regarding the management of women with endometriosis who may still require combined HRT following hysterectomy.
  • Nausea/vomiting in pregnancy — minor update. Further information added regarding the duration of treatment for ondansetron and metoclopramide in people with hyperemesis gravidarum, where experience in secondary care indicates usage for over 20 weeks of treatment with these medications.
  • Psychosis — minor update. Revised wording on periodicity of ECG monitoring with reference to three antipsychotic medications, pimozide, haloperidol, and sertindole. Added drug interaction information on methylphenidate and risperidone.
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