🔔 What's New in Guidelines

Updated first-line treatment algorithm adding SGLT2 inhibitors for those with established CVD or CKD. Revised HbA1c targets and individualised care approach.

Updated H. pylori eradication regimens to account for rising clarithromycin resistance. Bismuth quadruple therapy now recommended in areas with resistance >20%.

Updated blood pressure targets for adults with hypertension. Thiazide-like diuretics (e.g. indapamide) now preferred over conventional thiazides (bendroflumethiazide).

Lecanemab (Leqembi) not recommended for NHS England due to insufficient cost-effectiveness data. NICE concluded benefits did not justify the cost and infusion requirements.

Updated AED choices for focal and generalised epilepsy. Levetiracetam now co-first-line with lamotrigine for focal seizures. Valproate restrictions updated for people of childbearing potential.

Revised admission criteria for bronchiolitis. Updated guidance on high-flow nasal cannula (HFNC) oxygen therapy and management in paediatric settings.

MART (Maintenance And Reliever Therapy) with ICS/formoterol single inhaler now preferred Step 2 for adults. Replaces separate ICS + SABA approach for most patients.

Fidaxomicin and oral vancomycin are now equal first-line treatment options. Metronidazole no longer recommended as first-line due to inferior clinical outcomes.

Updated stroke risk scoring and anticoagulation guidance. Edoxaban added as a DOAC option alongside apixaban, rivaroxaban and dabigatran for stroke prevention in AF.

Dolutegravir-based regimens confirmed as preferred first-line ART for treatment-naive adults. Updated guidance on HIV screening intervals in primary care and sexual health settings.

Updated antiviral options including nirmatrelvir/ritonavir (Paxlovid). Revised criteria for at-risk groups eligible for treatment; updated hospital management pathways.

Updated resistance thresholds for empirical antibiotic selection across common infections. New IV-to-oral switching criteria to reduce unnecessary parenteral antibiotic use.

Direct oral anticoagulants (DOACs) now preferred over LMWH for most cancer-associated VTE. Exceptions include GI and GU tract cancers with higher bleeding risk.

Reaffirmed 90-minute door-to-balloon target for STEMI. Ticagrelor confirmed as preferred P2Y12 inhibitor over clopidogrel in most ACS presentations.

Updated polyp surveillance intervals and adenoma risk stratification. Low-risk adenomas now followed at 5 years; high-risk adenomas at 3 years with revised size and number thresholds.

SGLT2 inhibitors added as an option alongside metformin for people with T2DM at high cardiovascular risk, even without established CVD. GLP-1 agonists also recommended in selected patients.

SGLT2 inhibitors (dapagliflozin, empagliflozin) recommended for all HFrEF patients regardless of T2DM status. Four-pillar therapy now standard of care for HFrEF.

AI-assisted grading recommended for diabetic retinopathy screening programmes. Evidence shows AI can safely triage images, reducing burden on human graders while maintaining diagnostic accuracy.

Nitrofurantoin confirmed as first-line for uncomplicated lower UTI in women. Updated local resistance data incorporated; trimethoprim now second-line in many regions due to resistance.

eGFR thresholds revised for CKD staging. SGLT2 inhibitors (dapagliflozin, empagliflozin) now recommended for CKD with significant proteinuria (ACR >=22.6 mg/mmol) to slow progression.