Standard Treatment Guidelines and Essential Medicines List ...

1 Standard Treatment Guidelines and Essential Medicines List for South Africa Hospital Level, Adults 2019 Edition Electronic copies are available on National Department of Health Website: Mobile versions can be downloaded as EML Clinical Guide smartphone app from the relevant app stores - available for iOS and Android. Print copies may be obtained from: The Directorate: Affordable Medicines Private Bag X828 Pretoria 0001 First printed 1998 Second edition 2006 Third edition 2012 Fourth edition 2015 Fifth edition 2019 ISBN: 978-1-990938-49-8 NOTE: The information presented in these Guidelines conforms to the current medical, nursing and pharmaceutical practice.

2 Contributors and editors cannot be held responsible for errors, individual responses to Medicines and other consequences. Copyright 2019, 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. Suggested citation: National Department of Health, South Africa. Essential Drugs Programme. Hospital level (Adults) Standard Treatment Guidelines and Essential Medicines List.

3 5th ed. 2019. Published and funded by: The National Department of Health, Pretoria, Republic of South Africa. iii ACKNOWLEDGEMENTS This edition of the Adult Hospital Level Standard Treatment Guidelines is evidence of the dedication, technical expertise, skills, and considerable time offered up by the Adult Hospital Level Expert Review Committee. The Committee has enthusiastically evolved with the review process, embracing Health Technology Assessment principles as South Africa journeys towards Universal Health Coverage. Collaboration with various stakeholders was strengthened and we thank all for your constructive engagement.

4 We recommend continuous participation in the peer review consultative process and encourage the dissemination and implementation of these Guidelines . In particular, we would like to thank each Committee Member for their valuable contributions, and the Chairpersons of the Adult Hospital Level Expert Review Committee, Dr Black and Dr Dawood, for their unwavering commitment and support during this review process. NATIONAL Essential Medicines LIST COMMITTEE (2017 - present) Prof A Parrish (Chairperson) Mr K Mahlako Dr G Reubenson (Vice Chairperson) Mrs N Makalima Prof L Bamford Ms E Maramba Dr A Black (resigned) Ms T Matsitse Prof S Boschmans (resigned) Ms N Mazibuko Dr RC Chundu Prof M Mendelson (resigned) Dr K Cohen Ms N Mokoape (resigned) Dr D Dawood (2019-current) Ms N Mpanza Dr R de Waal Dr L Mvusi Mr M Dheda Mr R Naidoo Dr N Dlamini (resigned) Dr N Ndjeka Ms D du Plessis Dr N Ndwamato (resigned) Ms S Dube Dr L Padayachee Prof M Freeman (resigned) Dr Z Pinini Ms T Furumele (2019-current)

5 Mr W Ramkrishna (resigned) Mr A Gray Ms S Ramroop (resigned) Dr G Grobler Ms R Reddy Ms N Gumede Ms Z Rhemtula (2019-current) Dr P Holele (resigned) Dr A Robinson (resigned) Prof B Hoek (2020-current) Prof P Ruff Ms Y Johnson Mr G Steel (resigned) Brig Gen T Kgasago (resigned) Prof M Tshifularo (resigned) Dr T Kredo (2019-current) Mr G Tshitaudzi Ms F Loonat Dr K Vilakazi-Nhlapo (2019-current) Dr J Lotter (resigned) Mr R Wiseman Prof G Maartens Ms C Zeelie (resigned) ACKNOWLEDGEMENTS iv ADULT HOSPITAL LEVEL EXPERT REVIEW COMMITTEE (2017-2020) Dr A Black - Chair (resigned 2019) Dr H Dawood - Chair (2019-2020) Dr E Bera - Vice Chair Prof PJC Commerford Dr A Sherriff Dr RP Kaswa Dr S Takuva Dr AS Rossouw Dr GA Timothy Prof GS Gebhardt Prof R Coetzee Dr L Robertson Mr JM Nabyoma Dr R Griesel (resigned 2018) Dr Y Hookamchand (resigned 2018) Dr V Mpongoshe (resigned 2019) TECHNICAL AD HOC SUPPORT TO THE ADULT HOSPITAL LEVEL COMMITTEE (2017-2020)

6 Dr K Balme Dr J Nel Dr H Gunter Dr MFP van Jaarsveld Prof S Honikman Prof L Wallis Dr R Kularatne Dr L Weich Ms J Mueller MEDICINE REVIEW AUTHORS/PEER REVIEWERS Dr K Balme Dr H Gunter Prof AG Parrish Prof L Bamford Dr RP Kaswa Ms J Patterson Dr E Bera Dr SR Krause Dr G Reubenson Dr A Black Dr T Kredo Dr L Robertson Prof R Coetzee Ms TD Leong Dr AS Rossouw Prof K Cohen Ms P Letsoane Dr S Takuva Prof PJC Commerford Prof A Moodley Dr GA Timothy Dr H Dawood Dr MA Moorhouse Dr MFP van Jaarsveld Dr R de Waal Ms L Mopelo Ms M Wilkinson Prof GS Gebhardt Dr V Mpongoshe Mr R Wiseman Mr A Gray Mr JM Nabyoma Dr R Griessel Dr J Nel Evidence reviews (78) developed during this review cycle are accessible at: COSTINGS/ ECONOMIC ANALYSES Dr E Bera Ms V Mutyambizi (UCT) Ms E Chanikira (UCT) Dr J Miot (HE2RO) Prof GS Gebhardt Ms R Rapiti (Priceless-SA) Miss TD Leong Ms M Wilkinson (Cochrane-SA) Dr L Chola (Priceless-SA) Mr T Wilkinson (Priceless-SA/ UCT) Ms K Macquilkan (Priceless SA) Mr A Winch (Priceless SA) Costing/ economic analyses (12) developed during this review cycle are accessible at.

7 ACKNOWLEDGEMENTS v COMMENTS AND CONTRIBUTIONS Dr K Balme Prof L Jenkins Dr V Pillay-Fuentes Lorente Dr T Boltina Ms Y Johnson Dr F Pirie Dr M Braithwaite Dr W Jooste Dr P Raubenheimer Dr N Brey Dr T Kalk Dr G Reubenson Dr K Brouard Dr J Kanku Prof B Rayner Prof A Bryer Dr T Kemp Ms R Reddy Prof J Carr Dr D Kettles Dr M Redelinghuys Dr A Chin Ms B Koopman Prof G Richards Dr Chundu Ms S Kirsten Prof P Ruff Dr A Coetzee Dr L Lai King Dr A Scheibe Dr R Coetzee Dr R Krause Prof A Schutte Prof K Cohen Dr R Kularatne Mr R Setshedi Dr M Conradie Prof G Lamacraft Dr S Singh Dr T Crede Dr N Lister Prof M Sonderup Dr J Cunningham Prof V Louw Prof W Spearman Dr J Dave Prof D Lubbe Dr J Stanford Dr H Dawood Ms E Maramba Dr D Stanton Dr A de Villiers Dr K Mawson Dr C Stephen Prof K Dheda Dr S Meiring Dr J Taljaard Dr P Douglas-Jones Prof K Mlisana Dr A Thornton Prof A Doubell Dr S Mohangi Ms N Thipe Ms A du Toit Dr L Molife Dr N Tsabedze Dr R du Toit Prof J Moodley Dr IS Ukpe Prof S Dyer Dr MA Moorhouse Dr A Vachiat Dr R Freercks Prof A Motala Dr E van Duuren Ms M Gijzelaar Dr F Moti Dr MFP van Jaarsveld Prof AGS Gous Ms L Muller Dr R van Rensburg Prof N Govender Dr N Ndjeka Prof R van Zyl-Smit Dr T Hardcastle Dr SC

8 Nyoka-Mokgalong Ms C Vedalanker Ms H Hayes Prof AP Parrish Dr L Visser Dr E Hodgson Dr I Paruk Mr F Vorster Dr B Hodkinson Dr M Patel Dr S Walaza Ms H Hoffman Dr AJK Pecararo Prof L Wallis Dr N Horn Dr L Pein Dr L Weich Dr N Ismail Dr Petro Ms L Whitelaw Allergan Pharmaceuticals South Africa (Pty) Ltd National Committee on Confidential Enquiries into Maternal Deaths Novartis South Africa Pfizer Laboratories (Pty) Ltd Private Healthcare Information Standards Committee (PHISC) Psychological Society of South Africa: Sexuality & Gender Division South African HIV Clinicians Society Society for Endocrinology, Metabolism and Diabetes in South Africa South African Rheumatism Arthritis Association South African Gastroenterology Society ACKNOWLEDGEMENTS vi South African Medical Association South African Society of Anaesthesiologists South African Society of Clinical Pharmacy South African Society of Ophthalmology CLINICAL EDITORS Prof PJC Commerford Dr R de Waal Prof GS Gebhardt Prof G Maartens EDITORIAL Ms TD Leong Dr J Jugathpal Ms G Mngola Ms A Brewer Ms S Putter SECRETERIATEMs TD Leong Dr J Jugathpal Dr J Riddin Dr R Lancaster Ms S Govender LOGISTICS Ms P Ngobese Mr M Molewa DIRECTOR.

9 AFFORDABLE Medicines Ms K Jamaloodien vii TABLE OF CONTENTS Foreword i Introduction ii Acknowledgements iii Table of contents vii The Essential Medicines Concept xxiii How to use these Guidelines xxiv A guide to patient education in chronic diseases xxxiii CHAPTER 1.

10 ALIMENTARY TRACT Gastrointestinal disorders Bowel preparations Diverticulosis Gastro-oesophageal reflux disease (GORD) Hiatus hernia Inflammatory bowel disease Pancreatitis, acute Pancreatitis, chronic Peptic ulcer Hepatic disorders Hepatitis, non-viral