STANDARD TREATMENT GUIDELINES AND …

1 STANDARD TREATMENT GUIDELINESANDESSENTIAL MEDICINES LISTFOR SOUTH AFRICAPRIMARY HEALTH CARE LEVEL2008 EDITIONiiCopies may be obtained from:The Directorate: Pharmaceutical Programmes and PlanningPrivate Bag X828 Pretoria0001 ORDepartment of Health Website: printed 1996 Second edition 1998 Third edition 2003 Fourth edition 2008 ISBN: 978-1-920031-48-0 NOTE:The information presented in these GUIDELINES conforms to the current medical, nursing and pharmaceutical practice. It is provided in good faith. Contributors and editors cannot be held responsible for errors, individual responses to medicines and other consequences.

2 Copyright 2008, The National Department of part of this material may be reproduced, copied or adapted to meet local needs, without permission from the committee or the Department of Health, provided that the parts reproduced are distributed free of charge or at no cost not for profi by:The National Department of Health, Pretoria, South AfricaiiiFOREWORD In science the important thing is to modify and change one s ideas as science advances Herbert SpencerIt is our pleasure to introduce the fourth edition of the STANDARD TREATMENT GUIDELINES and essential Medicines List for Primary Health Care.

3 In keeping with the goals of the National Drug Policy, the review was done to keep pace with the advances in the fi eld of medicine . Changes in this edition are a refl ection of current epidemiology norms and recent developments in challenges facing the health sector are numerous but not effective and effi cient use of medicines will go a long way towards meeting these goal of evidence based medicine selection has been strengthened in this edition. Affordability, without compromising quality, has been taken into account.

4 The numerous comments received and involvement from stakeholders is heartening and has contributed enormously to the excellence of this edition. We are indebted to all experts, opinion leaders and users of this book for their STANDARD TREATMENT GUIDELINES and essential Drugs List is a living document and comments are invited in order to ensure appropriateness and responsiveness to emerging would like to congratulate the committee on completing the reviews and to thank them for their continued commitment to the process over the years despite their busy is our sincere hope that the healthcare workers will continue to utilise the STANDARD TREATMENT

5 GUIDELINES and essential medicine List in their efforts to providing quality care which we ourselves expect to receive. MS B HOGANMINISTER OF HEALTHivINTRODUCTIONM edicines consume a signifi cant portion of the total health care budget. Equitable access to affordable medicines remains a challenge. In accordance with the National Drug Policy, the STANDARD TREATMENT GUIDELINES and essential Medicines List ensure that cost-effective TREATMENT options are available to citizens of the country, and seeks to build capacity in health care workers at the Primary Health Care Level.

6 Emerging developments in medicine and scientifi c advances provided the basis for the review of the STANDARD TREATMENT GUIDELINES and essential medicine List. During this process consideration was given to factors such as evidence based therapeutics, prevailing medicine cost and practical experience. Where necessary, expert opinion was with wider stakeholders is an integral part of the review process. I am pleased to note that as a result of the productive feedback of users, this new edition has been completely updated and substantially have been made to ensure that GUIDELINES of priority programmes such as HIV and AIDS, TB, Chronic diseases, IMCI.

7 Etc are harmonised with the STANDARD TREATMENT GUIDELINES and essential medicine appeal is being made to all users to follow the recommended GUIDELINES at the back of the book when submitting comments or requesting additions or deletions of medicines from the list. Users are also encouraged to use the Adverse Drug Reaction Report Forms in the book. This will ensure that the quality of service is enhanced and will guide selection of appropriate medicine in would like to take this opportunity to thank the National essential Drugs List Committee, the Primary Health Care Level Expert Review Committee, the Chairpersons and all who contributed to the dedication and commitment to realising our vision of an accessible, caring and high quality health system is TD MSELEKUDIRECTOR-GENERAL.

8 HEALTHvACKNOWLEDGEMENTSWe wish to convey our sincere gratitude to all those who participated in the review of this edition. The advice, comments, criticisms and contributions from the various stakeholders including professional societies, expert committees and individuals, has gone a long way toward producing a hugely improved edition of the STANDARD TREATMENT GUIDELINES and essential Medicines List for Primary Health Care. Without the willingness to participate in this consultative process, this edition would not be have been particular, we would like to thank:The Chair of the Primary Health Care Level Expert Review Committee, Prof B W van de Wal, for his loyalty, continued commitment and tireless members of the Committee themselves, for sacrifi cing their time and for their dedication and willingness to share and Pudifi n for his technical and editorial support.

9 NATIONAL essential DRUGS LIST COMMITTEEMs M Hela (Chairperson) Prof L BamfordProf M Blockman Dr GPG BoonDr H Brits Prof BB HoekProf PM Jeena Ms Y JohnsonMs CC Kotzenberg Prof G MaartensProf B Maharaj Ms HM MaraisMs L Mahlangu Prof J MoodleyMr HT Mphaka Ms MNM NtshangaseDr AG Parrish Dr L PeinDr T Pillay Dr H SaeedMr P Setsiba Mr C ShabalalaMr GS Steel Ms N ThipaMr CJL van de Merwe Prof BW van de WalDr N XunduPRIMARY HEALTH CARE LEVEL EXPERT REVIEW COMMITTEEProf BW van de Wal (Chairman) Prof L BamfordDr GPG Boon Dr E BeraDr H Brits Prof I KatzProf G Maartens Prof B MaharajDr M Mashabane Sr G MdleleniSr MM Ntshangase Dr K ParbhooDr L Pein Dr H SaeedDr PZ Sinxadi Mr G SteelviCONSULTANTS Prof J AboobakerDr I van BiljonProf P CommerfordProf J HofmeyrProf D LabadariosProf D LewisProf Y OsmanProf B RaynerProf John RoddaProf C SzaboCOMMENTS AND CONTRIBUTIONSDr SE Abizu Mr Z AchmatProf M AdhikariProf G AinslieDr M ArcharyDr TJ AvenantMs L BakerDr P BarrowProf E BatemanDr M BatemanDr MO

10 BelloDr V BlackMs L BothamMs S BritsProf A BryerProf TR CarmichaelProf J CarrDr JM CarterMs M CassimjeeMs L ChanningDr B CheyipProf NO ChabikuliProf M ConnorProf P CooperDr A CoovadiaDr R CornickProf M CottonDr H DawoodProf K DhedaDr N R DlaminiDr W DuimDr MW du ToitDr L FairallProf V FritzDr J GoosenDr T GouldDr H GousDr Robin GreenDr P HaugProf D HellenbergDr L JenkinsDr L JonesDr G JordaanDr S KalulaProf B KiesDr H J KirbyDr K KlusmannDr K LecuonaProf S LevinProf AD MaraisProf R MashDr R MathibaMs H MoengMs DB MofukengDr ME MossProf G MullerDr DD MunsamyDr C NelProf KA NewtonDr J NuttallDr S OliverDr G PagetProf W Pienaar Dr V Pinkney-AtkinsonDr P PotterDr R PretoriusDr H W ProzeskyProf F J RaalProf R RaineDr AS RamdassProf GA RichardsProf H SaloojeeDr H SammonsMrs B SayedProf S SchaafDr A SchlemmerDr G ShermanMs JN ShongweviiDr A SmithDr FJ SmitDr H StaubMs L TerblancheDr D TheronDr V TihonDr B TippingDr C van DeventerDr K van der MerweDr C van DeventerMs T van Greunen Dr DJH VealeDr F VenterDr CC