Change log
Guideline-driven updates to topic pages, newest guideline date first.
Guideline date
Follow-up now has the INSPQ 2026 expedited partner therapy (TAP) rules. Gonorrhea: oral cefixime plus azithromycin only, not if the strain is cefixime-intermediate or resistant.
Guideline date
New Insomnia and Anxiety pages built on the October 2026 INESSS tool for a first benzodiazepine prescription in adults not already taking one. Cognitive-behavioural approaches (plus antidepressants for anxiety) come first; a benzodiazepine is a short add-on for severe symptoms, at most 4 weeks, with a stop plan from the first prescription and follow-up at 2-4 weeks.
Guideline date
New Immunization page built on the PIQ change list of 24 September 2026: 2026-2027 influenza, the mRNA RSV vaccine mRESVIA, RSV antibody for infants born before 32 weeks, a consolidated COVID-19 chapter for fall 2026, and the prednisone 20 mg/day or equivalent threshold.
Guideline date
New Cellulitis page built on the INESSS adult and child cellulitis tools of 24 July 2026, revised 23 September 2026: severity grading that sets route and duration, 5-day oral courses for most cases, narrow spectrum first, beta-lactam options for a penicillin label, and follow-up, return advice and referral.
Guideline date
New Thyroid page built on the INESSS free T4 (T4L) fiche of 18 September 2026: TSH first, free T4 second line or for central causes, what not to order (Choosing Wisely Canada), the CTFPHC advice against screening asymptomatic adults, and the SOGC levothyroxine TSH target before and in pregnancy after recurrent pregnancy loss.
Guideline date
New Anemia page built on the September 2026 INESSS IV iron protocol for adults. The update adds ferric carboxymaltose, an algorithm for adverse reactions during infusion, and clarified prevention for people with risk factors.
Guideline date
New Low back pain page built on the INESSS low back pain algorithm and the drug information INESSS added on 27 July 2026: red flags and when to image, drug choice by pain type, with start doses, maximum doses and duration, and follow-up by complexity.
Guideline date
New Menopause page built on the INESSS hormone therapy tool revised 24 February 2026. It covers when to start or defer, estradiol route, micronized progesterone or an LNG-IUD when the uterus is present, start doses, and follow-up of unexpected bleeding.
Guideline date
New Smoking cessation page built on the INESSS clinical tool of 2 December 2025 for tobacco and nicotine vaping from age 12. It covers the brief intervention, dependence and motivation, accompaniment plus pharmacotherapy, start doses, RAMQ coverage, follow-up and pregnancy, breastfeeding and under 18.
Guideline date
New Penicillin allergy page built on the INESSS clinical tool of August 2025, modified 3 November 2025. It covers assessing a reported penicillin label, choosing a beta-lactam by risk of recurrence, the provocation test, updating the label, and referral to allergology.
Guideline date
New Obesity page built on the August 2025 Obesity Canada pharmacotherapy update. Drugs are offered with health behaviour change at BMI 30 or more, or 27 or more with complications, and used long term when effective.
Guideline date
New Vaginitis page built on the INESSS protocol of January 2025 for unusual vaginal discharge and the INESSS Trichomonas vaginalis guide of January 2025. It covers bacterial vaginosis, candidiasis, trichomoniasis and cervicitis: when to treat, doses, pregnancy and breastfeeding, and when to reassess.
Guideline date
New Dyspepsia and H. pylori page built on the INESSS optimal use guide of December 2024 (English file updated 10 April 2025): warning signs and who to test, stool antigen or breath test after stopping PPIs for 2 weeks, 14-day quadruple therapy first, with no triple therapy, a test of cure at least 4 weeks after treatment, and a Long-term PPI card from the INESSS deprescribing algorithm of July 2025.
Guideline date
Treat now has an outpatient pelvic inflammatory disease grid (ceftriaxone, doxycycline, metronidazole: dose and duration). A new Follow-up section adds pelvic inflammatory disease re-examination.
Guideline date
New Headache page with the CHS 2024 prevention update: most CGRP-blocking drugs and candesartan get strong recommendations, topiramate drops to weak, gabapentin is weak against. Imaging and acute do-nots follow Choosing Wisely Canada.
Guideline date
New Depression page built on the September 2024 INESSS protocol for antidepressant follow-up: reassess every 2-4 weeks for the first 3 months; aim for remission (PHQ-9 under 5) and functional recovery (WSAS under 10). CANMAT 2023 guides the first treatment, and CCSMH 2021 covers age 65 and older.
Guideline date
A new Follow-up section lists test of cure for gonorrhea and chlamydia, reinfection screening, and partner contact, as written in the INESSS guide.
Guideline date
New Chronic kidney disease page built on KDIGO 2024, for adults not on dialysis: who to test, how to confirm and stage CKD, what slows it, follow-up labs and when to refer. The blood pressure target shows both: Québec (INESSS) systolic under 130, KDIGO under 120.
Guideline date
New Contraception page built on the INSPQ Québec contraception protocol, 2024 update, and its 2024 emergency contraception tool. It covers eligibility categories, when each method works at once, combined hormonal contraception contraindications and interactions, emergency contraception by delay, BMI and breastfeeding, and follow-up.
Guideline date
A new Follow-up section adds INESSS guidance on repeat urine culture, reassessment, pyelonephritis treated orally, and antibiotic prophylaxis follow-up.
Guideline date
New Asthma page built on the September 2023 INESSS tool for children and adults. From age 12, no SABA alone: every regimen contains ICS, with formoterol/budesonide or ICS with a SABA reliever as the two preferred options. The page also covers the action plan yellow zone, follow-up intervals, pregnancy and children under 12.
Guideline date
New Red eye page built on the three INESSS eye-care guides; the ocular herpes simplex guide was updated on 21 February 2023 to remove topical antivirals, since none is available in Canada. It covers alarm signs and slit-lamp delays, oral antiviral doses for ocular zoster and herpes simplex, and blepharitis care. Conjunctivitis rows, including daycare and school, come from the MSSS chapter of January 2024.
Guideline date
New Lyme disease page built on the INESSS adult and child guides of March 2021: diagnosis, treatment, follow-up and children's doses. Serology follows the INESSS diagnostic aid updated May 2025.
Guideline date
The Hyperlipidemia page adds the CCS 2021 urine albumin-to-creatinine ratio arm to chronic kidney disease as a statin indication: ACR ≥3 mg/mmol for at least 3 months, as well as eGFR <60 mL/min/1.73 m², except chronic dialysis.
Guideline date
Screening now shows the MSSS indicative table of STBBIs to test for according to the risk factors found.
Guideline date
New Dementia page built on the INESSS drug guide of March 2015 for Alzheimer disease and mixed dementia: start doses, titration, follow-up, switching and stopping. It adds the INESSS detection and diagnosis sheets, the two INESSS protocols of March 2020, and the MSSS primary-care drug table for behavioural symptoms of October 2024.