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«STANDARD TREATMENT GUIDELINES AND ESSENTIAL MEDICINES LIST MINISTRY OF HEALTH AND SOCIAL WELFARE FOURTH EDITION MAY, 2013 1|Page FOREWORD The ...»

-- [ Page 1 ] --

THE UNITED REPUBLIC OF TANZANIA

STANDARD TREATMENT GUIDELINES

AND ESSENTIAL MEDICINES LIST

MINISTRY OF HEALTH AND SOCIAL WELFARE

FOURTH EDITION

MAY, 2013

1|Page

FOREWORD

The Standard Treatment Guidelines (STG) and the National Essential Medicine List for Tanzania

(NEMLIT) was first published in 1991. The fourth edition includes new sections on symptoms and syndrome. The STGs have been updated and are consistent with current national guidelines for diagnosis and management of common diseases. The guidelines also reflect changes in the management of various diseases including asthma and hypertension following recommendations from WHO and experts from international medical associations and agencies.

There have been improvements in the format of treatment regimens, showing more clearly the classification of medicines by level of health care within the treatment guidelines, and not just in the NEMLIT.

The STG and NEMLIT aims at providing health practitioners with standardized guidance in making decisions about appropriate health care for specific conditions found in Tanzania. By using STGs, prescribing practices can be rationalized and patient outcomes can be improved while making optimum use of the limited resources for medicines. The NEMLIT attached to the STG retains its purpose of identifying medicines that are considered essential for the treatment of common disease conditions in Tanzania. The medicine list is in line with the World Health Organization (WHO) recommendations under Tanzania conditions. It follows the principles and concepts of essential medicines so as to simplify the management of medicines supply and support a streamlined logistics system.

This set of tools is meant to be a guide for quick reference and its recommendations are valid for most presentations of the conditions covered. Nevertheless, clinical judgment and experience will always prevail for adjustment of treatment in individual cases when necessary.

This new edition of STGs provides Medicines and Therapeutics Committees (MTCs) at our health institutions an opportunity to strengthen their role in improving therapeutics and management of medicines in practice. MTCs are requested to promote the concepts of evidence based selection of medicines and cost-effective treatment protocols and facilitate STGs to be applied in their specific practice settings, translating and incorporating into local guidelines, formularies and in-service training programmes.

The Ministry’s policy is that all public and private health workers in Tanzania will promote and adhere to these Standard Treatment Guidelines, and that prescribing, purchasing, labeling and dispensing of medicines should be by generic names as much as possible, and consistent with the level classification in the STGs and NEMLIT.

It is my hope that all health workers in Tanzania will find this document a useful tool in management of patients’ illinesses.

–  –  –

i|Page

ACKNOWLEDGEMENTS

The Ministry of Health and Social Welfare greatly appreciates the support of the Health Sector Program Support IV in the course of development of the Standard Treatment Guidelines and Essential Medicines List. The Ministry expresses much gratitude to the World Health Organization (WHO) for providing the technical support in reviewing these guidelines and the Danish Internation Developments Agency (DANIDA) for the financial support. It is anticipated that, the guidelines will be useful as tools for health professionals.

The Ministry wishes to acknowledge the following members of the the National Medicines and Therapeutic Committee (NMTC) for their valuable inputs, guidance and approval of the

document:

–  –  –

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HOW TO USE THE DOCUMENT

The guideline covers chapters of common diseases in Tanzania. Most chapters start with a title, a brief description of the topic, common clinical signs and symptoms of each disease, the diagnosis and differentials, investigations, treatments and supportive care. The document comprises the national Essential Medicines List (NEMLIT) which will be used in the public health facilities. The medicines will be used to treat the majority of public health problems and they should be available to health facilities at all time. The guideline also makes provision for referral of patients to higher health facilities.

The indices for all medicines used are found at the back of the guide book, together with the information on how to report the adverse drug reactions. All health care workers are encouraged to report suspected adverse drugs reactions (ADR) when the reaction is potentially serious or clinically significant. The guideline also, makes provision for referral of patients to higher health facilities see the referral form. The last pages of the guideline contain annexes, references as well as the Essential Medicines List.

It is important to remember that the recommended treatments provided in this document are evidence, clinically approved and are in consistent with the already existing WHO guidelines.





Comments that aim to improve these treatment guidelines will be appreciated all the time and the form for that purpose is appended.

–  –  –

FOREWORD

ACKNOWLEDGMENT

TABLE OF CONTENTS

ABBREVIATIONS AND SYMBOLS

CHAPTER ONE

SYNDROMIC APPROACH

1.0 PAIN

2.0 HEADACHE

3.0 FEVER

4.0 COUGH

5.0 CONVULSION

6.0 SHOCK

7.0 DEHYDRATION

8.0 HYPOGLYCEMIA

CHAPTER TWO

ORAL AND DENTAL CONDITION

1. 0 PERIODONTAL CONDITIONS

2.0 DENTAL CARIES

3.0 ODONTOGENIC AND NON-ODONTOGENIC OROFACIAL INFECTIONS

4.0 FUNGAL INFECTIONS

5.0 VIRAL INFECTIONS

6.0 APHTHOUS ULCERATION

7.0 POST EXTRACTION BLEEDING

v|Page

8.0 TOOTH SENSITIVITIES

9.0 TOOTH ERUPTION, SHEDDING AND EDENTULOUSNESS

10.0 MALOCCLUSIONS

11.0 TRAUMATIC DENTAL INJURIES

12.0 TUMOURS AND TUMOUR-LIKE CONDITIONS OF ORAL CAVITY AND FACIAL REGION

CHAPTER THREE

GASTRO INTESTINAL DISEASE CONDITION

1. 0 INFECTIONS OF GASTROINTESTINAL TRACT

2. 0 DISORDERS OF GASTROINTESTINAL TRACT

3.0 DISORDERS OF THE LIVER AND BILLIARY TRACT

CHAPTER FOUR

RESPIRATORY DISEASE CONDITIONS

1.0 ACUTE RESPIRATORY INFECTIONS (ARI)

2.0 BRONCHOSPASM

3 0 BRONCHITIS

4.0 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

5.0 OTHER RESPIRATORY INFECTIONS

CHAPTER FIVE

OBSTETRICAL/GYNAECOLOGICAL DISEASE CONDITIONS & CONTRACEPTION.85

1.0 INFECTION OF THE GENITAL-URINARY TACT

2.0 ABORTION

3.0 PREMATURE RAPTURE OF MEMBRANE

4.0 PROPHYLAXIS FOR CAESARIAN SECTION

5.0 NAUSEA AND VOMITING IN PREGNANCY

6.0 ANAEMIA DURING PREGNANCY

vi | P a g e

7.0 HYPERTENSION IN PREGNANCY

8.0 DIABETES IN PREGNANCY

9.0 HEART BURN IN PREGNANCY

10.0 RESPIRATORY DISTRESS SYDROME

11.0 STIMULATION OF LABOUR AND MYOMETRIAL RELAXATION

12.0 TERMINATION OF PREGNANCY

13.0 PREGNANCY AND LACTATION

14.0 PELVIC INFLAMMATORY DISEASES

15.0 HORMONAL CONTRACEPTION

16.0 ANTEPARTUM HAEMORRHAGE (APH

17.0 DYSMENORRHOEA

CHAPTER SIX

CARDIOVASCULAR DISEASE CONDITIONS

1.0 INFECTIVE ENDOCARDITIS

2.0 RHEUMATIC FEVER

3.0 VALVULAR HEART DISEASE AND CONGENITAL STRUCTURAL HEART DISEASE..…….109

4.0 HYPERTENSION…………………………………………………………………………………………….… 110

5.0 HEART FAILURE

6.0 PULMONARY OEDEMA

7.0 ACUTE CORONARY SYNDROMES

8.0 CHRONIC STABLE ANGINA PECTORIS

9.0 ATHEROSCLEROTIC PERIPHERAL DISEASE

10.0 ACUTE PULMONARY EMBOLISM

11.0 CARDIAC ARRHYTHMIAS/ DYSRHYTHMIAS

12.0 HEART BLOCK (SECOND OR THIRD DEGREE)

13.0 SINUS BRADYCARDIA & SINUS ARREST

vii | P a g e CHAPTER SEVEN

SKIN DISEASES AND ALLERGIC REACTIONS

1.0 BACTERIAL SKIN INFECTION

2.0 FUNGAL SKIN INFECTIONS

3.0 PARASITE INFECTION

4.0 VIRAL INFECTION

5.0 ALLERGIC CONDITIONS

6.0 OTHER SKIN DISEASES

CHAPTER EIGHT

MUSCULO SKELETAL AND JOINT DISEASE CONDITIONS

1.0 INFECTIONS

2.0 INFLAMMATORY CONDITIONS

3.0 LOW BACK PAIN

CHAPTER NINE

KIDNEY AND UROLOGICAL DISORDERS

1.0 KIDNEY DISEASES

2.0 UROLOGY DISORDERS

CHAPTER TEN

EAR, NOSE AND THROAT DISEASES

1.0 OTITIS (EXTERNA AND MEDIA)

2.0 ACUTE RHINITIS AND SINUSITIS

3.0 PHARYNGOTONSILLITIS

4.0 LARYNGITIS

5.0 ACUTE EPIGLOTITIS (AE)

6.0 RECURRENT RESPIRATORY PAPILLOMATOSIS (LARYNGEAL PAPILLOMAS).............. 182

7.0 EPISTAXIS

viii | P a g e

8.0 FOREIGN BODIES

CHAPTER ELEVEN

EYE DISEASE CONDITIONS

1.0 MAJOR BLINDING DISEASES

2.0 RED EYES

3.0 SQUINT

4.0 OCULAR SURFACE DISEASE

CHAPTER TWELVE

NERVOUS SYSTEM DISEASE CONDITIONS

1.0 INFECTIONS OF THE NERVOUS SYSTEM

2.0 MENTAL CONDITIONS

CHAPTER THIRTEEN

METABOLIC AND ENDOCRINE DISEASE CONDITIONS

1.0 DIABETES MELLITUS

2.0 HYPOGLYCAEMIA

3.0 DIABETIC KETOACIDOSIS

4.0 NON-KETOTIC HYPEROSMOLAR STATE (NKHS)

5.0 DIABETES AND OTHER CARDIOVASCULAR DISEASES

6.0 GESTATIONAL DIABETES MELLITUS

8.0 DIABETES IN CHILDREN

10.0 DIABETES KETOACIDOSIS (DKA)

11.0 HYPOTHYROIDISM

12.0 THYROTOXICOSIS

13.0 HYPERTHYROIDISM

CHAPTER FOURTEEN

HAEMATOLOGICAL DISEASE CONDITIONS

ix | P a g e

1.0 ANAEMIAS DUE TO RED CELL DISORDERS (NUTRITIONAL DISORDERS)................ 243

2.0BLEEDING DISORDERS

3.0 COAGULATION DISORDERS

CHAPTER FIFTEEN

TRAUMA & INJURIES

1.0 GENERAL MANAGEMENT OF TRAUMA

2.0 TRAUMATIC BRAIN INJURIES

3.0. INJURIES

4.0 BITES

5.0 BURNS

6.0 FOREIGN BODIES

CHAPTER SIXTEEN

MALIGNANT DISEASE CONDITIONS

1.0 GYNAECOLOGICAL MALIGNANCIES

2.0 CANCERS OF THE SKIN

3.0 HEAD AND NECK CANCERS

4. 0 GASTROINTESTINAL MALIGNANCIES

5.0 LUNG CANCER

6.0 BREAST CANCER

7.0 GENITO-URINARY MALIGNANCY

8.0 LYMPHOMAS

9.0 COMMONEST PAEDIATRIC MALIGNANCY

CHAPTER SEVENTEEN

MALARIA

1.0 Overview of Malaria

2.0 Treatment of Uncomplicated Malaria

x|Page

3.0 Treatment of Severe Malaria

4.0 Management of malaria in pregnancy

CHAPTER EIGHTEEN

TUBERCULOSIS AND LEPROSY

1.0 TUBERCULOSIS

2.0 TREATMENT OF TUBERCULOSIS IN SPECIAL CASES

3.0 LEPROSY

4.0 MULTIBACILLARY (MB) LEPROSY

CHAPTER NINETEEN

SEXUALLY TRANSMITTED INFECTIONS (STI)

1.0 GENERAL GUIDELINES

2.0 REASONING IN CHOOSING STI DRUG TREATMENT REGIMENS

3.0 THE SYNDROMIC TREATMENT OF STI

7.0 CHLAMYDIA INFECTIONS

8.0 SYPHILIS

9.0 WARTS

10.0 TRICHOMONIASIS

11.0 VAGINAL CANDIDIASIS

12.0 CHARTS ON SYNDROMIC TREATMENT OF STI

CHAPTER TWENTY

HUMAN IMUNUDEFICIENCY VIRUS (HIV)

1.0 TREATMENT OF HIV/AIDS IN ADULTS AND ADOLESCENTS

2.0 ANTIRETROVIRAL REGIMENS FOR HIV INFECTED INFANTS AND CHILDREN........... 339

3.0 USE OF ARVs IN SPECIAL CIRCUMSTANCES

4.0 HIV PREVENTION METHODS

CHAPTER TWENTY ONE

xi | P a g e OTHER VIRAL INFECTIONS

1.0 MEASLES

2.0 POLIOMYELITIS

3.0 VIRAL HEPATITIS

4.0 EXPANDED PROGRAM ON IMMUNIZATION

CHAPTER TWENTY TWO

OTHER PROTOZOA INFECTIONS

1.0 LEISHMANIASIS

2.0 TRYPANOSOMIASIS

CHAPTER TWENTY THREE

OTHER BACTERIAL INFECTIONS

1.0 ANTHRAX

2.0 MASTITIS (BREAST ABSCESS)

CHAPTER TWENTY FOUR

NUTRITIONAL DISORDERS

1.0 PROTEIN-ENERGY MALNUTRITION (PEM)

2.0 ANAEMIA

3.0 IODINE DEFICIENCY DISORDERS (IDD)

4.0 VITAMIN A DEFICIENCY (VAD)

5.0DEFICIENCY OF VITAMIN B1 (THIAMINE)

6.0 VITAMIN B2 (RIBOFLAVIN) DEFICIENCY

7.0 VITAMIN B3 (NIACIN) DEFICIENCY

8.0 VITAMIN B6 (PYRIDOXINE) DEFICIENCY

9.0 VITAMIN B12 (COBALAMIN) DEFICIENCY

10.0 FOLIC ACID DEFICIENCY

11.0 VITAMIN C (ASCORBIC ACID) DEFICIENCY

xii | P a g e

12.0 VITAMIN D DEFICIENCY

13.0 VITAMIN E (TOCOPHEROL) DEFICIENCY

14.0 VITAMIN K DEFICIENCY

15.0 ZINC DEFICIENCY

16.0 SELENIUM DEFICIENCY

17.0 CALCIUM DEFICIENCY

18.0 COPPER DEFICIENCY

19.0 MAGNESIUM DEFICIENCY

21.0 FLUORINE DEFICIENCY

CHAPTER TWENTY FIVE

POISONING

1.0 COMMON POISONINGS

3.0 PRINCIPLES FOR MANAGEMENT OF POISONS IN CONTACT WITH SKIN OR EYES.... 386

4.0 PRINCIPLES FOR MANAGEMENT OF INHALED POISONS

5.0 SPECIFIC POISONS

6.0 BITES

7.0 MANAGEMENT OF OTHER SOURCES OF POISONING (ENVENOMING)



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