Standard Treatment Guidelines and Medicines List for South ...

1 Standard Treatment Guidelines . AND. ESSENTIAL Medicines LIST. FOR. South AFRICA. hospital LEVEL. ADULTS. 2015 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. Fourth edition 2015. ISBN: 978-1-920031-95-4. 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 2015, 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 Suggested citation: Republic of South Africa. Essential Drugs Programme. hospital level (Adults) Standard Treatment Guidelines and Essential Medicines List. 4th ed. Republic of South Africa: National Department of Health;. 2015. Published and funded by: The National Department of Health, Pretoria, South Africa FOREWORD. It gives me great pleasure to present the Fourth Edition, of the Adult Standard Treatment Guidelines (STGs) and Essential Medicines List (EML). for hospital Level care. The system for the selection of essential Medicines in the South African public health sector is evolving as our country moves towards the implementation of National Health Insurance. The National Department of Health, through the National Drug Policy, remains committed to ensuring the availability and accessibility of good quality essential Medicines that are effective, safe, and affordable and, the rational use thereof.

3 The STGs and EML remains an important tool in achieving this goal. These Guidelines are as a result of a rigorous evidence based peer review process. Congratulations to the National Essential Medicines List and Adult Expert Review Committees and external stakeholders on a successful collaboration and revision. I commend their continued commitment to healthcare provision in South Africa. Access to previous editions of the Adult hospital Level STGs and EML was mainly paper-based. To strengthen access and implementation of the revised publication, the guideline will be supported by the development of a mobile application format. I believe that we should now leverage the capabilities of technology to facilitate efficient, point-of-care access to up-to- date medicine information. Ensuring that Guidelines become an integrated and useful part of health care remains a challenge.

4 Implementation of the revised edition of the STGs and EML calls for cooperation between all sectors of health care providers. It is the hope of the National Department of Health that the revised Guidelines will contribute towards greatly improved quality of care for our citizens. DR A MOTSOALEDI, MP. MINISTER OF HEALTH. DATE: i INTRODUCTION. Access to essential Medicines is a fundamental component in ensuring equitable health care to all South African citizens. The Standard Treatment Guidelines (STGs). and Essential Medicines List (EML) provides a platform for equitable access to safe, th effective, and affordable Treatment options. It is thus my honour to introduce the 4. Edition of the Adult hospital Level STGs and EML. Essential Medicines are selected through the review of available clinical evidence, considering efficacy, safety and affordability.

5 The STGs provide guidance for the rational use of these essential Medicines . New features have been incorporated into the revised Adult STGs and EML for hospital Level care. These include the level of evidence and supporting citations, new algorithms and a warnings and cautions for medicine use reference. Additionally, the revised edition of the STGs and EML will be available in mobile application format. This is intended to improve accessibility to all healthcare professionals at all levels of care, and allows health care professionals immediate access to up-to-date information and decision support at their fingertips. The extensive use of antimicrobials has resulted in drug resistance that threatens to reverse the life-saving power of these Medicines . The revised STGs and EML features a quick antimicrobial reference appendix supporting the initiative of antimicrobial stewardship.

6 In addition, a more comprehensive care package for anaesthesiology, pain and intensive care is included. The revised publication is the culmination of many months of intensive review by the National Essential Medicines List and Adult Expert Review Committees, as well as collaboration and peer review from various internal and external stakeholders including National Department of Health Programmes, Clinical Societies and Health Care Professionals. It is envisaged that the STGs and EML will undergo continuous improvement through the contributions of users, and therefore users are encouraged to submit their comments and suggestions to the National Department of Health. I am confident that the revised Guidelines will contribute towards promoting rational medicine use, preventing the development of AMR and improving the quality and safety of health care.

7 MS MP MATSOSO. DIRECTOR-GENERAL: HEALTH. DATE: ii ACKNOWLEDGEMENTS. We would like to convey our sincere gratitude and thanks to the Adult Expert Review Committee for their passion, dedication, technical expertise and commitment to this process. We thank you for sacrificing the time. We also thank the various stakeholders (doctors, pharmacists, nurses, dieticians, professional societies and other health care professionals) for their comments and contributions with submission of appropriate evidence and technical medicine reviews. Your willingness to participate in this peer review consultative process was integral in producing this excellent edition. We look forward to continuous constructive engagement. In particular, we would like to thank: The Chairperson of the Adult Expert Review Committee, Prof Parrish, for his tireless support, continued dedication and innovative ideas.

8 The Vice Chairperson of the Adult Expert Review Committee, Prof Blockman, for his commitment and contribution to the process. Prof Maartens for his technical and editorial support. NATIONAL ESSENTIAL Medicines LIST COMMITTEE (2014 2015). Mr GS Steel (Chairperson) Ms K Jamaloodien Prof L Bamford Dr F Benson Dr E Bera Prof M Blockman Prof GPG Boon (resigned) Dr C Clark Prof H Brits Mr M Dheda Dr N Dlamini Mrs D du Plessis Prof M Freeman Mr A Gray Dr G Grobler Dr P Holele Prof PM Jeena Ms Y Johnson Dr S Joubert Dr J Lamprecht (resigned). Prof G Maartens Dr P Mntla Mr HT Mphaka Dr L Mvusi Ms MNM Ntshangase Ms M Ndwande Prof AG Parrish Dr L Pein Dr Z Pinini Ms R Reddy Dr G Reubenson Dr C Scott Dr W Seaketso Ms N Thipa Prof BW van de Wal (resigned). NATIONAL ESSENTIAL DRUGS LIST COMMITTEE (2015 current). Prof G Maartens (Chairperson) Prof L Bamford Dr F Benson Dr E Bera Prof M Blockman Prof H Brits Dr C Clark Mr M Dheda iii Dr N Dlamini Ms D du Plessis Prof M Freeman Mr A Gray Dr G Grobler Dr P Holele Prof PM Jeena Ms Y Johnson Dr S Joubert Dr P Mntla (resigned).

9 Mr HT Mphaka Ms M Ndwande Ms MNM Ntshangase Dr L Mvusi Prof AG Parrish Dr L Pein Dr Z Pinini Ms R Reddy Dr G Reubenson Dr C Scott Dr W Seaketso Ms N Thipa ADULT EXPERT COMMITTEE. Prof AP Parrish (Chairperson) Dr AD Black Prof M Blockman (Vice Chairperson) Dr R Coetzee Prof PJ Commerford Dr MF Chughlay Dr AME du Plessis Dr S Joubert Prof G Lamacraft Dr N Nematswerani Prof F Suleman Dr MFPC van Jaarsveld CONSULTANTS AND MEDICINE REVIEW AUTHORS. Dr E Bera Dr V Black Mr P Daames Dr B Daya Dr EH Decloedt Dr PA de Wet Dr I Ebrahim Dr T Kredo Dr R Kularatne Dr N Govender Dr T Kredo Dr R Kularatne Dr R Lancaster Dr J Leigh Taylor Ms T Leong Prof G Maartens Dr M Makiwane Dr P Marwick Prof M Mendelson Dr J Miot Prof J Moodley Dr M Nejthardt Dr U Nqebele Dr M Raff Prof B Rayner Prof W Spearman Dr M Reddy Ms L Zeihen COMMENTS AND CONTRIBUTIONS.

10 Dr MS Abdool-Gaffar Mr K Helena Dr M Osman Dr S Adam Dr F Henning Dr AA Parker Dr P Alexandris Dr RE Hodgson Dr I Paruk Dr F Amod Dr N Horn Dr F Pirie Dr E Ancker Dr K Hornby Prof J Pretorius iv Dr K Balme Prof B Jacobson Prof PJ Pretorius Dr C Bamford Dr S Jaikarun Dr N Procter Dr D Barnard Dr L Jenkins Dr LB Profitt Dr F Bassa Mr D Joiner Prof F Raal Prof E Bateman Dr R Kaswa Dr SR Ramphal Dr Z Bayat Dr K Keddy Prof G Richards Dr S Bechan Dr T Kemp Dr C Roberts Ms Y Bekeur Dr H Khan Prof I Roberts Dr E Bera Prof W Kloeck Dr L Robertson Prof R Blaauw Dr E Klug Dr A Robins Prof K Boffard Prof C Koegelenberg Dr A Robinson Dr J Bornman Prof M Levin Prof JL Roos Prof E Buch Prof N Levitt Prof I Ross Dr A Burger Ms L Lifson Dr T Rossouw Prof J Carr Prof BG Lindeque Ms C Schubl Sr A Cruickshank Dr R Llewellyn Dr E Scriba Dr J Dave Prof Z Lockhat Dr S Sewpersad Dr H Dawood Prof C Lundgren Dr Sigcu Dr Daya Prof G Maartens Prof W Sinclair Dr E De Vries Dr S Maharaj Dr MGL Spruyt Dr EH Decloedt Dr J Mahlangu Dr M Steenkamp Mr D den Hollander Dr F Maleka Dr N Stempels Ms L Deysel Prof AD Marais Prof A Stulting Prof J Diedricks Dr L Marais Dr C Sutton Prof L Dreosti Ms C Marks Dr GE Thom Ms A Du Toit Prof HP Meyer Dr A Thornton Dr B Emmink Ms N Misra Prof M Tikly Dr J Espinaco Prof GM Mody Dr B Tipping Dr C Faber Dr P Monteiro Dr E Turton Dr Z Farina Prof J Moodley Dr IS Ukpe Prof C Feldman Prof Y Moosa Dr A Van Aswegan Mrs M Forgan Dr N Moran Dr D van der Merwe Dr R Freercks Prof AA Motala Dr N Van Zyl Smit Dr S French Prof Motswaledi Mrs C Vedalankar Dr S Gebhardt Prof D Muckart Prof L Visser Dr LN Goldstein Ms A Muller Prof LA Wallis Dr K Govender Dr L Nel