Standard Treatment Guidelines and Essential …

1 Standard Treatment Guidelines AND Essential MEDICINES LIST FOR SOUTH AFRICA HOSPITAL LEVEL ADULTS 2012 EDITION Copies may be obtained from: The Directorate: Affordable Medicines Private Bag X828 Pretoria 0001 OR Department of Health Website: First printed 1998 Second edition 2006 Third edition 2012 ISBN: 978-1-920031-71-8 NOTE: The information presented in these Guidelines conforms to the current medical, nursing and pharmaceutical practice. Contributors and editors cannot be held responsible for errors, individual responses to drugs and other consequences. Copyright 2012, The National Department of Health. Any 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 profit.

2 Published by: The National Department of Health, Pretoria, South Africa iFOREWORDI am proud to present the third edition of the Standard Treatment Guidelines and Essential Medicines List for Hospital level. Access to affordable Essential medicines is a vital component of an effi cient health care system. In our resource-constrained environment with the high burden of disease, the value of the Standard Treatment Guidelines and Essential Medicines List in ensuring affordable and equitable access to medicines should not be underestimated. Practice Guidelines should keep pace with changes in health care. A continuous review of the Standard Treatment Guidelines and Essential Medicines List is imperative to provide access to quality and needed health care to all South Africans.

3 I am pleased to note that evidence based medicine principles were, once again, applied during the review of this edition. We can be confi dent that using these Guidelines will contribute to achieving positive health outcomes for our am grateful to the members of the National Essential Drugs List Committee and the Expert Review Committees for completing the review despite their demanding schedules. I am also pleased with the number of contributions received in the form of comments and is our sincere wish that doctors and pharmacists, particularly those working at District and Regional Hospitals, will continue to incorporate the Standard Treatment Guidelines and Essential Medicines List in their daily practice.

4 This will contribute to realising our vision of a long and healthy life for all A MOTSOALEDI, MPMINISTER OF HEALTHDATE: 16/4/2012iiINTRODUCTIONIt is my pleasure to introduce the third edition of the Standard Treatment Guidelines and Essential Medicines List for Hospital Level. This edition marks the culmination of an intense and thorough review Standard Treatment Guidelines have been aligned with current developments in medicine and scientifi c advances. Clinical evidence was used in the selection of medicines. In addition, prevailing medicine cost, affordability, as well as practice implications were taken into consideration. Furthermore, harmonisation with priority Guidelines within the Department of Health has also been integral part of the review process is the consultation with key stakeholders.

5 This positive interaction has substantially contributed to the improvement and usability of the Standard Treatment Guidelines . I would like to thank everyone who took the time to comment when called upon to do are encouraged to provide feedback by following the recommended Guidelines at the back of the book when submitting comments or requesting additions or deletions of medicines from the list. Once again, the Adverse drug Reaction Report Form has been included in the book. Health care workers are requested to use the reporting form so that patient safety and medicine selection in the future is not of the Standard Treatment Guidelines and Essential Medicines List is still a major challenge.

6 The ineffi cient use of resources has a negative impact on equitable access to Essential medicines, and therefore on the quality of care. Provincial Pharmaceutical and Therapeutics Committees are encouraged to use the Standard Treatment Guidelines and Essential Medicines List to attain economic effi ciencies in terms of optimising available resources and the rational use of medicines. The National Essential Drugs List Committee and the Hospital Level Expert Review Committees are to be commended for this excellent achievement. Their dedication and commitment has contributed towards realising our vision of an accessible, caring and high quality health MP MATSOSODIRECTOR-GENERAL: HEALTHDATE: 20/4/2012iiiACKNOWLEDGEMENTSOur heartfelt thanks go to the National Essential Drugs List Committee and, in particular, the Expert Review Committee for the Hospital Level EDL (Adult) for their continued dedication and commitment to the process.

7 Without your passion and technical expertise, this publication would not have been would also like to thank the many doctors, pharmacists, professional societies and other health care professionals who contributed by way of comment, remarks and the supply of appropriate evidence. Your involvement in the consultative process is an integral part of the review and has undoubtedly contributed to the excellence of this Essential DRUGS LIST COMMITTEEMs H Zeeman (Chairperson) Prof L BamfordDr F Benson Prof M BlockmanProf GPG Boon Prof H BritsMr V Dalmini Prof M FreemanProf BB Hoek Prof PM JeenaMs Y Johnson Prof G MaartensProf B Maharaj Ms HM MaraisDr T Mbengashe Mr HT MphakaMs M Ndwandwe Ms MNM NtshangaseProf AG Parrish Dr L PeinDr T Pillay Dr H

8 SaeedMr GS Steel Ms N ThipaProf BW van de WalADULT EXPERT COMMITTEEMr GS Steel (Chairperson) Dr E BeraProf M Blockman Dr R de WaalDr I Hassen Prof G Maartens Prof B Maharaj Dr M Mashabane Ms J Munsamy Prof AG Parrish Dr H Prozesky Dr H SaeedDr P SinxadiCONSULTANTSProf J Anthony Prof S ArulkumaranDr K Bateman Prof J CarrProf F Cilliers Prof PJ CommerfordDr M Giaquinto Dr T HabibProf D Hall Dr F HenningDr Khan

9 Dr L KoningDr KA Lecuona Prof S LevinProf NS Levitt Prof P MangaivDr J Moodley Prof J MoodleyDr N Moran Dr C NelProf K Newton Prof RC Pattison Dr Sossa Prof G Todd Dr C van Deventer Prof Z van der SpuyDr L WeichCOMMENTS AND CONTRIBUTIONSProf Jamila Aboobaker Ms Gayle AdamsProf Gillian Ainsley Ms Gail AndersonProf John Anthony Prof BH Ascott-EvansDr KJ Bateman Dr S Beningfi eldProf Ahmed Bhigjee Dr Ulla BothaDr Belinda Bruwer Prof Alan BryerProf Trevor Carmichael Prof James CarrDr Jan Chabalala Prof Patrick CommerfordDr Halima Dawood Dr Elma de VriesDr Charles Dreyer Ms A DuToitDr H Duvenage Prof Roland EastmanProf Robin Emsley Dr LN GoldsteinDr Trevor Gould Dr Franclo HenningDr Linda Hering Dr S HitchcockProf Margaret Hoffman Dr L JenkinsProf R Jewkes Dr R JinaDr KD Jivan Dr Gregory JohnsonDr Gerhard Jordaan Prof Francois JordaanDr John Joska Prof PM JoubertDr E Karim Prof Bryan KiesProf

10 Liezl Koen Prof AJ KrugerDr Karin Lecuona Dr E LeePanProf Dinky (Naomi) Levitt Prof BG LindequeDr Richard Llewellyn Prof Pravin MangaProf David Marais Prof Marc Mendelson Dr Estie Meyer Prof David MeyerDr Andre Mochan Dr Jennifer MoodleyDr Z Moola Dr Neil MoranProf Ayesha Motala Dr GJ MullerDr Trusha Nana Dr Charles P NelProf Dana Niehaus Prof Nicolas NovitskyDr S Oliver Dr S OosthuizenDr Heidi Orth Dr Muhammed OsmanDr S Paruk Dr PatelProf Willie Pienaar Dr Anersha PillayDr Manesh Pillay Prof Fraser PirieProf PJ Pretorius Prof FJ RaalDr