10th March 2026

Agilio: Diagnosis and Treatment Guidance

This update contains 5 significant changes and 4 minor changes.

Significant Changes:

• Achilles tendinopathy — reviewed. A literature search was conducted in November

  2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key

  randomized controlled trials published since the last revision of the topic. The

  Prescribing information section was deleted and a link to the Prodigy topic on

  Analgesia – mild-to-moderate pain has been included in the Management section.

  The information about Achilles tendon rupture has been moved to the Complications

  section to aid navigation. No major changes to clinical recommendations have been

  made.

• Giant cell arteritis — reviewed. A literature search was conducted in November 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 recommendations have been made. An Assessment node has been added

  to the Diagnosis section in line with current Prodigy style. The section on Prescribing

  information has been removed and a link provided to the Prodigy topic on

  Corticosteroids – oral.

• Mastitis and breast abscess — reviewed. A literature search was conducted in

  December 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.

• Neuropathic pain – drug treatment — reviewed. A literature search was conducted

  in December 2025 – January 2026 to identify evidence-based guidelines, UK policy,

  systematic reviews, and key randomized controlled trials published since the last

  revision of this topic. Additional information and clarification have been added

  relating to risks of dependence and prescribing off-label. There has been minor

  reorganization of the prescribing section. There have been no major changes to the

  recommendations.

• Squint in children — reviewed. A literature search was conducted in November 2025

  to identify evidence-based guidelines, UK policy, systematic reviews, and key

  randomized controlled trials published since the last revision of the topic. There were

  no significant changes to the topic recommendations. Minor structural changes have

  been made to the topic to align the recommendations with the most recent

  literature.

Minor Changes:

• Acne vulgaris — minor update. The recommendation of two independent

  prescribers of isotretinoin therapy for under 18s has been updated to a single

  prescriber in line with an SPC update.

• Compression stockings — minor update to align information regarding ABPI with

  contemporary guidance.

• Gallstones — minor update in the wording of risk factors for gallstones.

• Sepsis — minor update. Revised the sepsis six in line with the Sepsis Trust manual

  7th edition.

10th February 2026

Agilio: Diagnosis and Treatment Guidance

This update contains 6 significant changes and 12 minor changes.

Significant Changes:

• Contraception – IUS/IUD — reviewed. A literature search was conducted in September 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. More detail has been added to the sections on follow-up advice, new-onset pelvic pain and uterine perforation in line with guidance from the College of Reproductive and Sexual Health. No major changes to recommendations have been made.
• Gilbert’s syndrome — reviewed. A literature search was conducted in October 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.
• Itch – widespread — reviewed. A literature search was conducted in November 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature.
• Obstructive sleep apnoea syndrome — minor update. Table 1 in the treatment section has been updated for clarity. The recommendations remain the same.
• Platelets – abnormal counts and cancer — reviewed. A literature search was conducted in October 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last version of this topic. The topic structure has been amended to aid navigation and reduce duplication. The management sections have been expanded and updated in line with current evidence in the literature.
• Support for adult carers — reviewed. A literature search was conducted in October 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 recommendations have been made, but the topic has been restructured for clarity.

Minor Changes: 

• Bipolar disorder — minor update. Revised wording regarding monitoring of hba1c and prolactin for some atypical antipsychotics.
• Boils, carbuncles, and staphylococcal carriage — minor update. Minor typographical error corrected.
• Cervical screening — minor update. Section ‘What is the Cervical Screening Programme’ also updated to a 5 year recall.
• Child maltreatment — minor update. Definition for whether a child is “independently mobile” has been added, in line with the December 2025 update to Child maltreatment: when to suspect maltreatment in under 18s.
• Chronic obstructive pulmonary disease— minor update. Table 1 in the treatment section has been updated for clarity. The recommendations remain the same.
• Hypertension — minor update. Minor change to the order of referral criteria in the management section.
• Influenza – seasonal— minor update. Information on when antivirals can be prescribed has been clarified.
• Prostate cancer — minor update. Added detail on the range of potential false negative testing for PSA.
• Psychosis — minor update. Revised wording regarding monitoring of hba1c and prolatin for some atypical antipsychotics.
• Shingles — minor update. Information on eligible cohorts for shingles vaccination has been updated in line with updated NHS guidance.
• Smoking cessation — minor update. Added detail to advise that although e-cigarettes cannot currently be prescribed or supplied by NHS smoking cessation clinics the majority of local authority smoking cessation clinics do provide them as part of a harm reduction approach.
• Urticaria — minor update. Added more information on titrating dose of antihistamines in the prescribing section.

9th December 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 4 significant changes and 8 minor changes.

Significant Changes:

• Analgesia – mild-to-moderate pain — 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 version of this topic. Changes have been made to
  recommendations in line with the guideline from the National Institute for
  Health and Care Excellence (NICE) on chronic pain, and in line with
  publication of additional warnings from the Medicines and Healthcare
  products Regulatory Agency (MHRA) on the risk of dependence and
  addiction from prolonged use of opioids for non-cancer pain.
• Contraception – emergency — reviewed. A literature search was
  conducted in August 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 have been made to align
  with updated guidance from the College of Sexual and Reproductive
  Healthcare (CoSRH) (formerly known as the Faculty of Sexual and
  Reproductive Healthcare). Text has been updated to reflect a revised
  recommendation from CoSRH which states that no interruption of
  breastfeeding is necessary following a single dose of ulipristal acetate
  when given for emergency contraception CoSRH, 2025.
• Hyponatraemia — reviewed. A literature search was conducted in
  September 2025 to identify evidence-based guidelines, UK policy,
  systematic reviews and key randomized controlled trials published since
  the last version of this topic. No major changes to clinical
  recommendations have been made.
• Macular degeneration – age-related — reviewed. A literature search
  was conducted in September 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.

Minor Changes:

• Autism in adults — minor update. Added additional information
  regarding possible undiagnosed autism in older adults.
• Benign paroxysmal positional vertigo — minor update. A minor
  typographical error has been corrected.
• Constipation — minor update. Information that naldemedine is an option
  for people with short-duration opioid-induced constipation has been added
  in line with the nice technology appraisal naldemedine for treating opioid-
  induced constipation.
• Influenza – seasonal — minor update. Updated to align with the updated
  nice guideline ng253 suspected sepsis in people aged 16 or over.

11th November 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes and 11 minor changes.

Significant changes:

• Anticoagulation – oral —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. No major changes to clinical recommendations have been made.
• Contraception – progestogen-only methods — 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 the topic. No major changes to recommendations have been made. Minor changes have been made to align with updated guidance from the College of Sexual and Reproductive Healthcare (formerly known as the Faculty of Sexual and Reproductive Healthcare).
• Diabetes – type 1 — 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 recommendations have been updated in line with evidence in current literature, including the use of diabetes-specific autoantibody testing in adults at diagnosis, and when to suspect hypoglycaemia. The sections on insulin therapy, self-monitoring of blood glucose, and management of hypoglycaemia have been removed, and links to the Prodigy topic on Insulin therapy in Type 1 diabetes have been provided.
• Earwax — reviewed. A literature search was conducted from September to October 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No significant changes to clinical recommendations have been made.
• HIV infection and AIDS — reviewed. A literature search was conducted in August 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last version of this topic. The topic has been restructured for clarity, and recommendations have been updated in line with current evidence and guidance.
• Mental health in students — reviewed. A literature search was conducted in August 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to the topic, updates to the background information, and basis for recommendation sections in line with the identified literature.
• Osgood-Schlatter disease — reviewed. A literature search was conducted in September 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 recommendations have been made.
• Tennis elbow — reviewed. A literature search was conducted in August 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 recommendations have been made.

Minor changes:

• Anaemia – iron deficiency— minor update. Added information about normal haemoglobin and low ferritin levels in menstruating pre-menopausal women who may benefit from referral for intravenous iron therapy, when symptomatic.
• Antenatal care – uncomplicated pregnancy — minor update. The information about which immunizations to discuss at the booking appointment has been updated to include respiratory syncytial virus (RSV), and COVID vaccination has been removed as pregnant women are no longer included in the vaccination programme.
• Bipolar disorder — minor update. Typographical error corrected.
• Cellulitis – acute — minor update. Added information on drug interaction between rifampicin and doxycycline.
• Chronic obstructive pulmonary disease — minor update. Changes have been made to the recommendation on when to consider referral to a specialist in respiratory medicine to consider starting oral prophylactic antibiotic therapy in line with NICE guideline Chronic obstructive pulmonary disease in over 16s: diagnosis and management and the British Thoracic Society Guideline for the use of long-term macrolides in adults with respiratory disease.
• Hypertension — minor update. Removed interaction between calcium channel blockers and theophylline and aminophylline to align with the BNF drug monograph.
• Leg ulcer – venous — minor update. Added information on drug interaction between rifampicin and doxycycline.
• Rosacea — minor update. Added information on drug interaction between rifampicin and doxycycline.
• Sensory neuropathy — minor update. The information that a serum protein electrophoresis with immunofixation test can be considered for people with sensory neuropathy has been moved to the section on additional investigations.
• Sinusitis — minor update. Added information on drug interaction between rifampicin and doxycycline.
• Urethritis – male — minor update. Added information on drug interaction between rifampicin and doxycycline.

14th October 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 7 significant changes and 13 minor changes.

Significant changes:

• Acute Childhood Limp — reviewed. A literature search was conducted in August 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 recommendations have been made.
• Addison’s disease — reviewed. A literature search was conducted in August 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recommendations from the NICE guideline Adrenal insufficiency: identification and management have been incorporated into this topic.
• Baker’s cyst — 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. No major changes to recommendations have been made.
• Constipation in children — reviewed. A literature search was conducted in August 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No changes have been made to the recommendations.
• Glaucoma — 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 this topic.
• Multiple myeloma — 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 this topic. No major changes to the recommendations have been made.
• Tiredness/fatigue in adults — 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. Recommendations have been updated in line with current evidence in the literature. Text regarding the diagnosis and management of suspected or confirmed myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been removed and links to a new Prodigy topic on Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been written.

Minor changes:

• Bipolar — minor update. Timing of post-dose lithium updated to 10-14 hours in line with Maudsley Prescribing guidance, 2025. Wording surrounding the use of contraception for men and boys on valporate has been updated to be more in line with NICE guidance.
• Cellulitis — minor update. Doxycycline has been added as a first-line alternative for people allergic to penicillin in line with the updated BLS/LSN Guidelines on the management of cellulitis in lymphoedema.
• Cervical Screening — minor update. Revised screening interval to 5 years for women aged 25-49 years in line with the National Screening Programme.
• Cough – acute with chest signs in children — minor update. Management of community aquired pneumonia updated in line with NICE, 2025.
• COVID 19 — minor update. Updated with vaccines available for autumn 2025.
• Erectile dysfunction — minor update. Minor typographical error corrected.
• Giant cell arthritis — minor update. A duplicated section of text has been removed.
• Heart failure — minor update. Recommendations have been aligned to the updated NICE, 2025 guideline Chronic heart failure in adults: diagnosis and management. Prescribing sections have been added for mineralocorticoid receptor antagonists (MRAs) and angiotensin receptor-neprilysin inhibitors (ARNIs), angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) have also been updated and aligned with the NICE guideline.
• Hypertension — minor update. The sections on monitoring abnormal results for people taking a renin-angiotensin system antagonist have been updated in line with the recommendations in the NICE guideline Chronic heart failure in adults: diagnosis and management.
• Lipid modification – CVD prevention — minor update. Typographical error corrected.
• Migraine — minor update. Added prescribing section for candesartan.
• Obesity — minor update. A typographical error has been corrected.
• Scabies — minor update. Revised wording on prescribing a second dose of ivermectin after 7 days to enhance effectiveness.

9th September 2025

Agilio: Diagnosis and Treatment Guidance

This update contains 12 significant changes and 10 minor changes.Significant changes:

• Bone and soft tissue sarcoma – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.
• Brain and central nervous system cancers – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.
• Breast cancer – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral.
• Corticosteroids – topical (skin), nose, and eyes — 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 version of this topic. There have been no major changes to the recommendations.
• Childhood cancer — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic
• Gastrointestinal tract (lower) cancers – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral.
• Gastrointestinal tract (upper) cancers – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.
• Gynaecological cancers – recognition and referral — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.
• Insulin therapy in type 1 diabetes — 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 this topic. The recommendations have been updated in line with current evidence in the literature, specifically the indications for insulin pump therapy, continuous glucose monitoring (CGM), and the definition of what blood glucose level constitutes an alert value for hypoglycaemia.
• Meningitis – bacterial meningitis and meningococcal disease — 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 the topic. Dosage for ceftriaxone for pre-hospital management has been updated to be in line with recommendation from the BNFC.
• Rosacea — 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 the topic..
• Urological cancers — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.

Minor changes:

• Corticosteroids – inhaled — minor update. The sections on Actions of corticosteroids and Steroid alert cards have been revised. Broken links have been fixed.
• Corticosteroids – oral — minor update. The sections on Contraindications and cautions, Initiation, and Steroid alert cards have been revised. A typographical error has also been corrected.
• Deep vein thrombosis — minor update. Wording changed in the summary section describing the diagnosis of deep vein thrombosis to align more closely with NICE guidance NG158.
• Immunizations – seasonal influenza — minor update. Influenza vaccines have been updated in line with those available in the UK for the 2025 to 2026 season.
• Irritable bowel syndrome — minor update. Links to IBS Network have been removed.
• Migraine — minor update. Added prescribing section for candesartan.
• Obesity — minor update. Quality standards have been updated in line with the NICE QS 212 Overweight and Obesity Management.
• Otitis externa — minor update. Reference to Otomize spray has been removed as the product has been discontinued.
• Prostate cancer — minor update. Added prevalence data on mortality by ethnicity. Added information relating to Black men being more likely to have metastatic cancer at time of diagnosis. Revised wording on PSA testing in men over the age of 79 and added further information to the basis for information regarding the difference between advice from NICE and the AoMRC in this age group.
• Tuberculosis — minor update. Definition of extensively drug-resistant tuberculosis has been updated in line with the 2021 updated WHO definition.