The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2024. This month there are four guidelines that impact upon primary care.
The Urinary tract infection (recurrent): antimicrobial prescribing guideline has been updated. It sets out sets out an antimicrobial prescribing strategy for preventing recurrent urinary tract infections in children, young people and adults who do not have a catheter. This update makes new recommendations on methenamine hippurate as a preventative treatment and amends existing recommendations on referral and seeking specialist advice, oestrogen for prevention, and choice of antibiotic or antiseptic prophylaxis.
The Tirzepatide for managing overweight and obesity technology appraisal has been published. Tirzepatide is recommended as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity in adults, only if they have:
- an initial body mass index (BMI) of at least 35 kg/m2 and
- at least 1 weight-related comorbidity.
It is recommended to use a lower BMI threshold (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds. If less than 5% of the initial weight has been lost after 6 months on the highest tolerated dose, a decision should be made on whether to continue treatment, taking into account the benefits and risks of treatment for the person.
It should be noted that the usual 90 period for implementation has been extended to 180 days with a further 3 year period to increase eligibility in stages based on health need and clinical benefit. It is also predicted that is could take up to 9 years to create a mature treatment pathway for obesity in primary care.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Vibegron (Obgemsa®) has been accepted for use in the symptomatic treatment of adult patients with overactive bladder (OAB) syndrome. It is noted that this treatment offers an additional choice in the therapeutic class of beta-3 adrenergic receptor agonists.
Levodopa / carbidopa / entacapone intestinal gel (Lecigon®) has been rejected for the treatment of advanced Parkinson's disease with severe motor fluctuations and hyperkinesia or dyskinesia when available oral combinations of Parkinson medicinal products have not given satisfactory results. The submitting company did not present a sufficiently robust clinical or economic analysis to gain acceptance by SMC.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
During November 2024 Clinical Knowledge Summaries were published or updated in the following areas.
The Functional neurological disorder topic is new. All of the topics have been reviewed and updated with minor structural and layout changes. The Infectious mononucleosis (glandular fever) topic has been renamed to reflect common terminology in the literature and the age cut-off below which to arrange Epstein-Barr virus (EBV) serology testing in children has been changed from 12 years to 4 years. The Raynaud's phenomenon topic has been updated such that the recommended dose of sustained-release nifedipine is in line with the consensus best practice pathway of the UK Scleroderma Study Group. The Trichomoniasis topic has been updated with the addition of information on the risk factors, prognosis and differential diagnosis and the diagnosis section includes information on sampling using nucleic acid amplification testing.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
Several years ago, Prescribing Advice for GPs got a Twitter (now X) account. If you have accounts on Bluesky or Mastodon, you can follow Prescribing Advice for GPs to get automatic notifications of new content. There are links in the navigation bar on the right too.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2024. This month there are four guidelines that impact upon primary care.
The Menopause: identification and management guideline has been updated. It covers identifying and managing menopause, including in people with premature ovarian insufficiency. This update reviewed the evidence and made new recommendations on:
- managing genitourinary symptoms associated with the menopause
- the effects of hormone replacement therapy on specific health outcomes (including breast, endometrial and ovarian cancer, cardiovascular disease, dementia and life expectancy)
- cognitive behavioural therapy to manage menopause-associated symptoms.
The Endometriosis: diagnosis and management guideline has been updated. It covers diagnosing and managing endometriosis, including where fertility is a priority. This update reviewed the evidence and made new or updated recommendations on diagnosis. The recommendations on symptoms and signs and information and support were also updated.
The Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) guideline has been published. It covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks.
The Asthma pathway (BTS, NICE, SIGN) guideline has been published. It links to recommendations and resources from the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) on diagnosing, monitoring and managing asthma in adults, young people and children.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
