standard treatment guidelines and essential medicines list for south africa hospital level paediatrics

656 Pages·2017·5.31 MB·English

by  Windows User

STANDARD TREATMENT GUIDELINES
AND
ESSENTIAL MEDICINES LIST
FOR
SOUTH AFRICA

HOSPITAL LEVEL
PAEDIATRICS

2017 EDITION
First printed 1998

Second edition 2006

Third edition 2013

Fourth edition 2017

Electronic copies can be obtained from the National Department of Health

Website:

• http://www.health.gov.za/index.php/standard-treatment-guidelines-
and-essential-medicines-list

Additionally, the updated Paediatric Standard Treatment Guidelines and
Essential Medicines List will be added to the mobile application, “EML Clinical
Guide”. This mobile application can be downloaded on android, IOS and
windows operating systems, from the relevant app stores.

ISBN: 978-1-920031-99-2

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 2017, 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 Department of Health,
provided that the parts reproduced are distributed free of charge or at no cost
– not for profit.

Published by:

The National Department of Health, Pretoria, South Africa
FOREWORD

"Children are our greatest treasure. They are our future."
— Nelson Mandela

Our children are our next generation, and as a vulnerable group, it is
imperative that their health and wellbeing is a priority. To this end I am proud
to present the fourth edition of the Paediatric Hospital Level Standard
Treatment Guidelines (STGs) and Essential Medicines (EML).

As we move to the era of National Health Insurance with an integrated health
care system to service the needs of all, it is imperative that the health of our
children is prioritised, to ensure the next generation is well taken care of.

I am happy to present the STG and EML in electronic format, now available
on your cellphones. This makes access to information that you need to care
for our patients much easier.

The latest edition of the Paediatric Hospital Level STGs and EML is a
culmination of many efforts, and we are immensely grateful to all those who
participated in the review process.

It is our hope that healthcare workers will continue to utilise the STGs and
EML in their endeavors while caring for our young patients.

DR A MOTSOALEDI, MP
MINISTER OF HEALTH
DATE: 14/12/2017
i
INTRODUCTION

The National Department of Health (NDoH) is committed to ensuring an
adequate and reliable supply of safe, cost-effective medicines of acceptable
quality to all citizens of South Africa, and ensuring the rational use of these
medicines by prescribers, dispensers and consumers. I am, therefore,
pleased to introduce the fourth edition of the Paediatric Hospital Level
Standard Treatment Guidelines (STGs) and Essential Medicines List (EML),
a tool that can be used to achieve this goal.

The STGs and EML development processes ensure for the selection of safe,
effective and cost-effective medicines, and provide a framework for their use
to ensure rational medicine use by healthcare professionals and patients.

With the move to the electronic mobile application platform, it is our hope that
the most up-to-date information will be easily accessible to all healthcare
professionals as they need it.

The review of the Paediatric Hospital Level STGs and EML has been the
collective efforts of an Expert Review Committee, National Essential Medicine
List Committee and external stakeholders involved in paediatric care.

I would like to take this opportunity to thank all those who participated and
contributed to the review process, and continue to promote rational medicine
use in their respective healthcare and teaching settings.

It is our hope that healthcare professionals will continue to make use of the
STGs and EML in their efforts to provide the best possible care, and ensure
that all the healthcare needs of our children are met.

MP MATSOSO
DIRECTOR-GENERAL: HEALTH
DATE: 22/01/2018
ii
ACKNOWLEDGEMENTS

Without the continued dedication of the members of the Paediatric Expert
Review Committee for the Hospital Level Essential Medicines List, this
edition of the Standard Treatment Guidelines and Essential Medicines List
would not have been possible. The quality of this edition was further
enhanced by the contribution of many doctors, pharmacists, professional
societies and other health care professionals. We are humbled by the
wi ll ing ness to participate in the consultative peer review process. We hope
that, with renewed enthusiasm, future editions will benefit from your
contributions.

NATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2013 – 2015)
Mr G Steel (Chairperson) Dr S Joubert
Ms K Jamaloodien (Vice Chairperson) Dr J Lamprech t
Prof L Bamford Prof G Maarte ns
Dr F Benson Mr T Mphaka
Dr E Bera Dr L Mvusi
Prof M Blockman Ms M Ndwand we
Prof H Brits Ms M Ntshang ase
Dr C Clark Prof A Parrish
Dr N Dlamini Dr L Pein
Ms D Du Plessis Dr Z Pinini
Prof M Freeman Ms R Reddy
Mr A Gray Dr G Reubens on
Dr G Grobler Dr C Scott
Prof B Hoek Dr W Seaketso
Dr P Holele Ms N Thipa
Prof P Jeena Prof B van de Wal
Ms Y Johnson

NATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2015 - 2016)
Prof G Maartens (Chairperson) Dr S Joubert
Prof L Bamford Mr T Mphaka
Dr F Benson Dr L Mvusi
Dr E Bera Dr L Mvusi
Prof M Blockman Ms M Ndwand we
Prof H Brits Ms B Ngxowa
Dr C Clark Ms M Ntshang ase
Mr M Dheda Prof A Parrish
Dr N Dlamini Dr L Pein
Ms D Du Plessis Dr Z Pinini
Prof M Freeman Ms R Reddy
Mr A Gray Dr G Reubens on
Dr G Grobler Dr C Scott
Dr P Holele Dr W Seaketso
Prof P Jeena Ms N Thipa
Ms Y Johnson

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NATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2017– current)
Prof A Parrish (Chairperson) Mrs N Makalima
Dr G Reubenson (Vice Chairperson) Ms E Maramba
Prof L Bamford Ms T Matsitse
Dr A Black Ms N Mazibuko
Prof S Boschmans Prof M Mendelson

Dr RC Chundu Ms N Mokoape

Dr K Cohen Ms N Mpanza

Dr R de Waal Dr L Mvusi

Mr M Dheda Mr R Naidoo

Dr N Dlamini Dr N Ndjeka

Ms D du Plessis Dr N Ndwamato

Ms S Dube Dr L Padayachee

Prof M Freeman Dr Z Pinini

Mr A Gray Mr W Ramkrishna

Dr G Grobler Ms S Ramroop

Ms N Gumede Ms R Reddy

Dr P Holele Dr A Robinson
Ms Y Johnson Prof P Ruff
Brig Gen T Kgasago Mr G Steel
Dr J Lotter Prof M Tshifularo
Prof G Maartens Mr G Tshitaudzi
Mr K Mahlako

PAEDIATRIC EXPERT REVIEW COMMITTEE
Mr A Gray (Chairperson) Dr L Mubaiwa
Prof PM Jeena (Vice Chairperson) Dr G Reubenson
Dr M Archary Dr P Soko
Prof L Bamford Dr C Sutton
Dr K Harper Dr P Langa (resigned)
Dr J Kriel Mr H Sablay (resigned)
Dr S Mda

CONSULTANTS
Dr H Alison
Prof N Schellack

COMMENTS AND CONTRIBUTIONS
Ms B Adam Prof R Lakier
Dr J Ambler Prof G Lamacraft
Dr I Appel Dr C Lee
Dr K Balme Prof M Levin
Dr K Bester Dr N Makubalo
Dr H Buys Dr H Meyer
Dr A Chateu Dr P Mogane
Dr J Cloete Dr B Mrara
iv
Prof MR Davids Dr AJ Niehaus
Prof A Davidson Dr R Nieuvweld
Dr N Davies Dr J Nuttall
Dr T De MaayerWits Prof J Poole
Dr T Dennis Dr J Potgieter
Prof BJS Diedericks Dr C Rajah
Prof B Eley Dr A Redfern
Dr A Engelbrecht Dr L Robertson
Dr L Fairlie Dr B Rossouw
Prof U Feucht Prof R Seedat
Dr R Gray Prof Dr N Sipambo
R Green Dr U Dr C Stephen
Hallbauer Dr A Vanker
Dr S Hawkridge Prof S Velaphi
Prof J Hewitson Dr L Visser
Dr C Hlela Dr W Vogel
Dr P Jooste Dr R Wainwright
Dr J Joshi Prof A Westwood
Dr G Kali Dr G Wilson
Dr K Kemp Prof H Zar
Ms S Kisten Prof E Zöllner
Dr W Kuhn
SAHIVSOC - South African HIV Clinicians Society
Innovative Pharmaceutical Association of South Africa (IPASA)
The South African Medical Association

CLINICAL EDITING
Dr T Dennis Dr J Strong

EDITORIAL
Ms G Mngola

SECRETARIATE
Dr J Jugathpal Ms T Leong
Dr J Riddin Dr R Lancaster

LOGISTICS
Ms P Ngobese Mr M Molewa

CLUSTER MANAGER: SECTOR WIDE PROCUREMENT
Mr Gavin Steel

DIRECTOR: AFFORDABLE MEDICINES
Ms K Jamaloodien
v
TABLE OF CONTENTS

Foreword i
Introduction ii
Acknowledgements iii
Table of Contents vi
The Essential Medicines Concept xx
How to use this book xxii
A guide to patient adherence in chronic disease xxvii

CHAPTER 1: EMERGENCIES AND TRAUMA 1
1.1 Paediatric emergencies 1
1.1.1 Triage 1
1.1.2 Resuscitation of the child 3
1.1.3 Anaphylaxis/Anaphylactic Reactions 5
1.1.4 Cardiorespiratory arrest 7
1.1.5 Convulsions, Not Febrile Convulsions 10
1.1.6 Inhalation, foreign body 10
1.1.7 Shock 11
1.1.8 Intra-osseous infusion in emergencies 15
1.1.9 Post resuscitation care 16
1.2 Trauma 17
1.2.1 Burns 17

CHAPTER 2: ALIMENTARY TRACT 24
2.1 Dental and oral disorders 24
2.1.1 Gingivitis, uncomplicated 24
2.1.2 Peridontitis 24
2.1.3 Necrotising Peridontitis 25
2.1.4 Candidiasis, oral 25
2.1.5 Aphthous ulcers 26
2.1.6 Herpes gingivostomatitis 26
2.2 Gastrointestinal disorders 27
2.2.1 Cholera 27
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2.2.2 Constipation/faecal loading 29
2.2.3 Cystic fibrosis 30
2.2.4 Diarrhoea, acute 31
2.2.5 Persistent diarrhoea 42
2.2.6 Diarrhoea, chronic other than post-infectious 44
2.2.7 Dysentery 45
2.2.8 Gastro-oesophageal reflux disease (GORD) 47
2.2.9 Peptic ulcer disease 48
2.3 Hepatic disorders 49
2.3.1 Cirrhosis 49
2.3.2 Chronic cholestasis 50
2.3.3 Portal hypertension 51
2.3.3.1 Bleeding oesophageal varices 51
2.3.3.2 Ascites, due to portal hypertension 52
2.3.4 Hepatitis, viral, acute 53
2.3.5 Hepatitis, toxin induced, acute 54
2.3.6 Hepatitis, chronic, autoimmune 55
2.3.7 Hepatitis B, chronic 56
2.3.8 Hepatitis C, chronic 57
2.3.9 Liver failure, acute 57
2.4 Malnutrition 60
2.4.1 Malnutrition, severe acute 60
2.5 Rickets 71
2.6 Worm bolus 72
2.7 Recurrent abdominal pain 73

CHAPTER 3: BLOOD AND BLOOD-FORMING ORGANS 75
Approach to a child with a haemotological problem 75

3.1 Anaemia, aplastic 76
3.2 Anaemia, haemolytic 78
3.2.1 Thalassaemia 80
3.2.2 Anaemia, sickle cell 80
3.3 Anaemia, megaloblastic 82
3.4 Anaemia, iron deficiency 83

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3.5 Anaemia of chronic disorders (infection or disease) 85
3.6 Haemophilia A and B 86
3.7 Von Willebrand disease 89
3.8 Haemorrhagic disease of the newborn 90
3.9 Immune thrombocytopaenic purpura (ITP) 90
Thrombotic thrombocytopaenic purpura/haemolytic
3.10 uraemic syndrome 92
3.11 Disseminated intravascular coagulation 93
3.12 Venous thrombo-embolic disease 94
3.13 Special considerations in HIV infected children 96
3.13.1 Thrombocytopaenia 96

CHAPTER 4: CARDIOVASCULAR SYSTEM 98
4.1 Cardiac dysrhythmias 98
4.2 Congenital heart disease (CHD) 102
Cyanotic congenital heart disease with hypoxaemia
4.2.1 attacks/spells (hypercyanotic spells) 103
4.2.2 Tetrology of Fallot 104
4.2.3 Congenital heart disease with left to right shunt 105
4.3 Endocarditis, infective 106
4.4 Rheumatic fever, acute 110
4.5 Myocarditis 112
4.6 Dilated cardiomyopathy 113
4.7 Pericardial Effusion 114
4.8 Pericarditis 116
4.9 Heart failure 117
4.9.1 Heart failure, acute with pulmonary oedema 118
4.9.2 Heart failure, maintenance therapy 119
4.10 Dyslipidaemia 120
4.11 Hypertension in children 122
4.11.1 Hypertension, acute severe 132
4.11.2 Hypertension, chronic 133
4.12 Children with prosthetic heart valves 136
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