NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.
The guideline was developed by the National Clinical Guideline Centre. The Centre worked with a group of healthcare professionals (including consultants, GPs and nurses), patients and carers, and technical staff, who reviewed the evidence and drafted the recommendations. The recommendations were finalised after public consultation.
The methods and processes for developing NICE clinical guidelines are described in The guidelines manual. This guideline updates and replaces NICE clinical guideline 20 (published October 2004). This guidance also updates and replaces NICE technology appraisal 76 (published March 2004) and NICE technology appraisal 79 (published April 2004).
Recommendations are marked as , [2004, amended 2012],  or [new 2012].
 indicates that the evidence has not been updated and reviewed since 2004.
[2004, amended 2012] indicates that the evidence has not been updated and reviewed since 2004 but a small amendment has been made to the recommendation.
 indicates that the evidence has been reviewed but no changes have been made to the recommendation.
[new 2012] indicates that the evidence has been reviewed and the recommendation has been updated or added.
The recommendations from this guideline have been incorporated into a NICE Pathway. We have produced information for the public explaining this guideline. Tools to help you put the guideline into practice and information about the evidence it is based on are also available.
This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.
Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
© National Institute for Health and Clinical Excellence 2011. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.