You’ll find some of the newest guidelines relevant to Primary Care below, along with a few key takeaways from each one of them.
Some of these guidelines are dense – but don’t worry, over at Pathway, they’re all neatly summarized and broken down into digestible chunks to make them easier to understand.
Sepsis - from the Society of Critical Care Medicine (SCCM 2025), the American College of Chest Physicians (ACCP 2024), and the Infectious Diseases Society of America (IDSA 2023), among others: -
Consider obtaining critical care ultrasound for targeted volume management in acutely ill adult patients to improve clinical outcomes. (C)
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Consider measuring blood lactate in adult patients with suspected sepsis. (C)
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Consider administering IV crystalloids up to 30 mL/kg in the initial phase in adult patients with sepsis or septic shock, with adjustments based on clinical context and frequent reassessments. Consider using an individualized approach in the optimization phase. (C)
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Use the qSOFA score to identify patients with potential sepsis. (A)
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Obtain a urine culture and two sets of blood cultures before initiating antimicrobial treatment. (A)
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Administer parenteral high-dose broad-spectrum antimicrobials within the first hour after the clinical assumption of sepsis. (A)
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Perform source control including removal of foreign bodies, decompression of obstruction, and drainage of abscesses in the urinary tract. (A)
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Interstitial cystitis/painful bladder syndrome - from the Canadian Urological Association (CUA 2025), the European Association of Urology (EAU 2024), and the American Urological Association (AUA 2022): - Diagnose patients with symptoms according to the EAU definition, after primary exclusion of specific diseases, with primary BPS by subtype and phenotype. (A)
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Use a validated symptom and QoL scoring instrument for initial assessment and follow-up. (A)
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Perform rigid cystoscopy under general anesthesia in patients with bladder pain, in order to exclude other diseases, and to classify IC/BPS into subtypes. (A)
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Offer subtype and phenotype-oriented therapy for the treatment of primary BPS. (A)
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Offer amitriptyline for the treatment of patients with primary BPS. (A)
Wilson’s Disease - from the European Association for the Study of the Liver (EASL/ERN-Rare Liver 2025), the European Association for the Study of the Liver (EASL 2024), and the American Association for the Study of Liver Diseases (AASLD 2022), among others: - Suspect WD in patients with ALF and Coombs-negative hemolysis, Kayser-Fleischer rings, or suggestive neurological symptoms, as these findings are highly indicative of WD. (B)
- Obtain serum ceruloplasmin and 24-hour urinary copper excretion measurements, and relative exchangeable copper if available, in siblings and first-degree relatives (parents and offspring of an index case). Evaluate clinical symptoms and obtain liver tests. (B)
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Obtain molecular testing in first-degree relatives presenting with abnormalities of copper metabolism or abnormal liver tests. (B)
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Obtain LFTs, liver imaging, and noninvasive fibrosis testing to assess for liver involvement in patients with suspected WD presenting with predominantly neurological or neuropsychiatric manifestations. (B)
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Obtain genetic ATP7B analysis to confirm the diagnosis of WD, recognizing that it may enable family screening. (B)
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Obtain a brain MRI in all patients with suspected WD presenting with predominantly neurological or neuropsychiatric manifestations to search for abnormalities, especially in the basal ganglia, thalamus, brainstem, and cerebellum. (B)
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Initiate chelators as the primary choice in patients with significant liver disease, including features of significant fibrosis and cirrhosis, liver failure, and hemolysis. (B)
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Advise avoiding frequent dietary intake of food containing high concentrations of copper in symptomatic patients with WD until remission or stabilization of signs and symptoms, particularly in the first year of treatment. (B)
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Wilson’s Disease Overview
Scabies - from the British Association for Sexual Health and HIV (BASHH 2025), the American Academy of Family Physicians (AAFP 2019), and the International Union Against Sexually Transmitted Infections (IUSTI 2017): - Suspect scabies in patients with a pruritic, papular rash in the typical distribution and pruritus in close contacts. Recognize that the classic burrows in webs and creases may not be present. (B)
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Offer any of the following as first-line therapy for uncomplicated classical scabies:
- permethrin 5% cream, applied and left for 12 hours; reapplied 1-2 weeks later given that one cream application often does not achieve full skin coverage
- ivermectin PO 200 mcg/kg on day 1 followed by a second dose on day 8. (A)
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Consider offering malathion 0.5% aqueous liquid emulsion if recommended treatments have failed, are unavailable, or are thought to cause adverse effects in specific patients. (B)
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Offer a combination of oral and topical antiparasitic agents (such as permethrin 5% cream or benzyl benzoate combined with 5% tea tree oil, if available) and a topical keratolytic agent (such as lactic acid and urea in sorbolene cream). Add systemic antibacterials when required. (B)
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Obtain a careful re-examination, including skin scrapings, burrow ink test, and dermoscopy where available, in case of itch beyond 4 weeks after the last (second dose) administration of a primary recommended scabicide treatment. (E)
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Ensure contact tracing and notification of partners, household members and other close contacts from the previous 2 months prior to the onset of symptoms. (E)
Chronic pelvic pain in women - from the American Academy of Family Physicians (AAFP 2025), the American Society of Regional Anesthesia and Pain Medicine (ASRA/AAPM/ASIPP 2024), and the European Association of Urology (EAU 2024), among others: - Elicit a detailed history and perform a focused abdominal, musculoskeletal, and pelvic examination in all patients with chronic pelvic pain. Assess for common comorbidities, including behavioral health disorders and other chronic pain conditions. (B)
- Obtain pelvic ultrasound to identify pelvic pathologies that may contribute to chronic pelvic pain. (B)
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Consider implementing a biopsychosocial approach with a multimodal, interdisciplinary treatment plan for chronic pelvic pain when a clear etiology is absent. (C)
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Consider offering NSAIDs for the treatment of chronic pelvic pain. (C)
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Offer opioids and other drugs of addiction/dependency following a multidisciplinary assessment and only after other reasonable treatments have been tried and failed. (A)
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Consider offering SNRIs, such as duloxetine, or TCAs for the treatment of chronic pelvic pain. (C)
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Consider offering patient education and cognitive behavior therapy, with or without sex therapy, to improve coping strategies and QoL in patients with chronic pelvic pain. (C)
Acknowledgments: - Editorial Team: Jeremy Swisher, MD, Cole Phillips, MD, Khudhur Moh, MD, Hovhannes Karapetyan, MD
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