Standard Treatment Guidelines And Essential Medicines

STANDARD TREATMENT GUIDELINESANDESSENTIAL MEDICINES LISTFORSOUTH AFRICAHOSPITAL LEVELPAEDIATRICS2017 EDITION

First printed 1998Second edition 2006Third edition 2013Fourth edition 2017Electronic copies can be obtained from the National Department of HealthWebsite: ally, the updated Paediatric Standard Treatment Guidelines andEssential Medicines List will be added to the mobile application, “EML ClinicalGuide”.This mobile application can be downloaded on android, IOS andwindows operating systems, from the relevant app stores.ISBN: 978-1-920031-99-2Note:The information presented in these guidelines conforms to the currentmedical, nursing and pharmaceutical practice.Contributors and editorscannot be held responsible for errors, individual responses to drugs andother consequences. Copyright 2017, The National Department of Health.Any part of this material may be reproduced, copied or adapted to meet localneeds, 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 MandelaOur children are our next generation, and as a vulnerable group, it isimperative that their health and wellbeing is a priority. To this end I am proudto present the fourth edition of the Paediatric Hospital Level StandardTreatment Guidelines (STGs) and Essential Medicines (EML).As we move to the era of National Health Insurance with an integrated healthcare system to service the needs of all, it is imperative that the health of ourchildren 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 availableon your cellphones. This makes access to information that you need to carefor our patients much easier.The latest edition of the Paediatric Hospital Level STGs and EML is aculmination of many efforts, and we are immensely grateful to all those whoparticipated in the review process.It is our hope that healthcare workers will continue to utilise the STGs andEML in their endeavors while caring for our young patients.DR A MOTSOALEDI, MPMINISTER OF HEALTHDATE: 14/12/2017i

INTRODUCTIONThe National Department of Health (NDoH) is committed to ensuring anadequate and reliable supply of safe, cost-effective medicines of acceptablequality to all citizens of South Africa, and ensuring the rational use of thesemedicines by prescribers, dispensers and consumers.I am, therefore,pleased to introduce the fourth edition of the Paediatric Hospital LevelStandard 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 useto ensure rational medicine use by healthcare professionals and patients.With the move to the electronic mobile application platform, it is our hope thatthe most up-to-date information will be easily accessible to all healthcareprofessionals as they need it.The review of the Paediatric Hospital Level STGs and EML has been thecollective efforts of an Expert Review Committee, National Essential MedicineList Committee and external stakeholders involved in paediatric care.I would like to take this opportunity to thank all those who participated andcontributed to the review process, and continue to promote rational medicineuse in their respective healthcare and teaching settings.It is our hope that healthcare professionals will continue to make use of theSTGs and EML in their efforts to provide the best possible care, and ensurethat all the healthcare needs of our children are met.MP MATSOSODIRECTOR-GENERAL: HEALTHDATE: 22/01/2018ii

ACKNOWLEDGEMENTSWithout the continued dedication of the members of the Paediatric ExpertReview Committee for the Hospital Level Essential Medicines List, thisedition of the Standard Treatment Guidelines and Essential Medicines Listwould not have been possible.The quality of this edition was furtherenhanced by the contribution of many doctors, pharmacists, professionalsocieties and other health care professionals. We are humbled by thewi ll ing ness to participate in the consultative peer review process. We hopethat, with renewed enthusiasm, future editions will benefit from yourcontributions.NATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2013 – 2015)Mr G Steel (Chairperson)Dr S JoubertMs K Jamaloodien (Vice Chairperson)Dr J Lamprech tProf L BamfordProf G Maarte nsDr F BensonMr T MphakaDr E BeraDr L MvusiProf M BlockmanMs M Ndwand weProf H BritsMs M Ntshang aseDr C ClarkProf A ParrishDr N DlaminiDr L PeinMs D Du PlessisDr Z PininiProf M FreemanMs R ReddyMr A GrayDr G Reubens onDr G GroblerDr C ScottProf B HoekDr W SeaketsoDr P HoleleMs N ThipaProf P JeenaProf B van de WalMs Y JohnsonNATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2015 - 2016)Prof G Maartens (Chairperson)Dr S JoubertProf L BamfordMr T MphakaDr F BensonDr L MvusiDr E BeraDr L MvusiProf M BlockmanMs M Ndwand weProf H BritsMs B NgxowaDr C ClarkMs M Ntshang aseMr M DhedaProf A ParrishDr N DlaminiDr L PeinMs D Du PlessisDr Z PininiProf M FreemanMs R ReddyMr A GrayDr G Reubens onDr G GroblerDr C ScottDr P HoleleDr W SeaketsoProf P JeenaMs N ThipaMs Y Johnsoniii

NATIONAL ESSENTIAL MEDICINES LIST COMMITTEE (2017– current)Prof A Parrish (Chairperson)Mrs N MakalimaDr G Reubenson (Vice Chairperson)Ms E MarambaProf L BamfordMs T MatsitseDr A BlackMs N MazibukoProf S BoschmansProf M MendelsonDr RC ChunduMs N MokoapeDr K CohenMs N MpanzaDr R de WaalDr L MvusiMr M DhedaMr R NaidooDr N DlaminiDr N NdjekaMs D du PlessisDr N NdwamatoMs S DubeDr L PadayacheeProf M FreemanDr Z PininiMr A GrayMr W RamkrishnaDr G GroblerMs S RamroopMs N GumedeMs R ReddyDr P HoleleDr A RobinsonMs Y JohnsonProf P RuffBrig Gen T KgasagoMr G SteelDr J LotterProf M TshifularoProf G MaartensMr G TshitaudziMr K MahlakoPAEDIATRIC EXPERT REVIEW COMMITTEEMr A Gray (Chairperson)Dr L MubaiwaDr G ReubensonProf PM Jeena (Vice Chairperson)Dr M ArcharyDr P SokoProf L BamfordDr C SuttonDr K HarperDr P Langa (resigned)Dr J KrielMr H Sablay (resigned)Dr S MdaCONSULTANTSDr H AlisonProf N SchellackCOMMENTS AND CONTRIBUTIONSMs B AdamDr J AmblerDr I AppelDr K BalmeDr K BesterDr H BuysDr A ChateuDr J CloeteProf R LakierProf G LamacraftDr C LeeProf M LevinDr N MakubaloDr H MeyerDr P MoganeDr B Mraraiv

Prof MR DavidsDr AJ NiehausProf A DavidsonDr R NieuvweldDr N DaviesDr J NuttallDr T De MaayerWitsProf J PooleDr T DennisDr J PotgieterProf BJS DiedericksDr C RajahDr A RedfernProf B EleyDr A EngelbrechtDr L RobertsonDr L FairlieDr B RossouwProf U FeuchtProf R SeedatDr N SipamboDr R Gray ProfDr C StephenR Green Dr UDr A VankerHallbauerDr S HawkridgeProf S VelaphiDr L VisserProf J HewitsonDr W VogelDr C HlelaDr R WainwrightDr P JoosteProf A WestwoodDr J JoshiDr G WilsonDr G KaliProf H ZarDr K KempProf E ZöllnerMs S KistenDr W KuhnSAHIVSOC - South African HIV Clinicians SocietyInnovative Pharmaceutical Association of South Africa (IPASA)The South African Medical AssociationCLINICAL EDITINGDr T DennisDr J StrongEDITORIALMs G MngolaSECRETARIATEDr J JugathpalDr J RiddinMs T LeongDr R LancasterLOGISTICSMs P NgobeseMr M MolewaCLUSTER MANAGER: SECTOR WIDE PROCUREMENTMr Gavin SteelDIRECTOR: AFFORDABLE MEDICINESMs K Jamaloodienv

TABLE OF Table of ContentsviThe Essential Medicines ConceptxxHow to use this bookxxiiA guide to patient adherence in chronic diseasexxviiCHAPTER 1: EMERGENCIES AND TRAUMA11.1Paediatric emergencies11.1.1Triage11.1.2Resuscitation of the child31.1.3Anaphylaxis/Anaphylactic Reactions51.1.4Cardiorespiratory arrest71.1.5Convulsions, Not Febrile Convulsions101.1.6Inhalation, foreign body101.1.7Shock111.1.8Intra-osseous infusion in emergencies151.1.9Post resuscitation care16Trauma17Burns171.21.2.124CHAPTER 2: ALIMENTARY TRACT2.1Dental and oral disorders242.1.1Gingivitis, uncomplicated242.1.2Peridontitis242.1.3Necrotising Peridontitis252.1.4Candidiasis, oral252.1.5Aphthous ulcers262.1.6Herpes gingivostomatitis262.22.2.1Gastrointestinal disorders27Cholera27vi

2.2.2Constipation/faecal loading292.2.3Cystic fibrosis302.2.4Diarrhoea, acute312.2.5Persistent diarrhoea422.2.6Diarrhoea, chronic other than hageal reflux disease (GORD)472.2.9Peptic ulcer disease48Hepatic disorders492.3.1Cirrhosis492.3.2Chronic cholestasis502.3.32.3Portal hypertension512.3.3.1Bleeding oesophageal varices512.3.3.2Ascites, due to portal hypertension522.3.4Hepatitis, viral, acute532.3.5Hepatitis, toxin induced, acute542.3.6Hepatitis, chronic, autoimmune552.3.7Hepatitis B, chronic562.3.8Hepatitis C, chronic572.3.9Liver failure, acute57Malnutrition60Malnutrition, severe acute602.5Rickets712.6Worm bolus722.7Recurrent abdominal pain732.42.4.175CHAPTER 3: BLOOD AND BLOOD-FORMING ORGANSApproach to a child with a haemotological problem753.1Anaemia, aplastic763.2Anaemia, haemolytic783.2.1Thalassaemia803.2.2Anaemia, sickle cell803.3Anaemia, megaloblastic823.4Anaemia, iron deficiency83vii

3.5Anaemia of chronic disorders (infection or disease)853.6Haemophilia A and B863.7Von Willebrand disease893.8Haemorrhagic disease of the newborn903.9903.10Immune thrombocytopaenic purpura (ITP)Thrombotic thrombocytopaenic purpura/haemolyticuraemic syndrome923.11Disseminated intravascular coagulation933.12Venous thrombo-embolic disease943.13Special considerations in HIV infected children96Thrombocytopaenia96CHAPTER 4: CARDIOVASCULAR SYSTEM983.13.14.1Cardiac dysrhythmias4.24.2.1Congenital heart disease (CHD)Cyanotic congenital heart disease with hypoxaemiaattacks/spells (hypercyanotic spells)1034.2.2Tetrology of Fallot1044.2.3Congenital heart disease with left to right shunt1054.3Endocarditis, infective1064.4Rheumatic fever, acute1104.5Myocarditis1124.6Dilated cardiomyopathy1134.7Pericardial Effusion1144.8Pericarditis1164.9Heart failure1174.9.1Heart failure, acute with pulmonary oedema1184.9.2Heart failure, maintenance therapy1194.10Dyslipidaemia1204.11Hypertension in children1224.11.1Hypertension, acute severe1324.11.2Hypertension, chronic133Children with prosthetic heart valves1364.1298102viii

139CHAPTER 5: DERMATOLOGY5.1Bullae1395.1.1Epidermolysis Bullosa1395.1.2Staphylococcal scalded skin syndrome1395.1.3Chronic bullous disease of childhood140Erythema and desquamation140Erythema multiformeStevens-Johnson Syndrome (SJS)/Toxic EpidermalNecrosis (TEN)140142Macules and papules1445.3.1Drug reactions1445.3.2Acne1455.3.3Cellulitis and 6Psoriasis1495.3.7Urticaria1505.3.8Tinea ococcaemia1515.4.2Henoch-Schönlein purpura1515.4.3Immune thrombocytopaenic purpura (ITP)152Vesicles and pustules1525.5.15.5Infections - vesicles and pustules1525.5.2Skin and mucosal disorders in HIV1525.5.2.1HIV papular pruritic eruption1525.5.2.2Kaposi neous haemangiomas154156CHAPTER 6: NEPHROLOGICAL/UROLOGICAL DISORDERS6.1Post streptococcal glomerulonephritis1566.2Urinary tract infection (UTI)159ix

6.3Nephrotic syndrome1636.4Acute kidney injury (renal failure, acute)1696.5Chronic kidney disease (renal failure, chronic)1746.6Enuresis180181CHAPTER 7: ENDOCRINE SYSTEM7.1Disorders of sexual development (DSD)1817.2Adrenal hyperplasia, congenital1827.3Adrenal insufficiency, acute1837.4Diabetes insipidus1847.5Diabetes mellitus185Type 1 diabetes mellitus185Guidelines for management of diabetics on sick daysDeabetes mellitus, insulin dependent: acutecomplications1961987.5.2.1Cerebral oedema in diabetic ketoacidosis (DKA)1987.5.2.2Diabetic ketoacidosis1997.5.2.3Hypoglycaemia in diabetics2047.5.2.4Diabetic nephropathy2067.5.2.5Dyslipidaemia2077.5.3Diabetes mellitus in adolescents2077.5.4Diabetes mellitus, type 22087.6Hypoglycaemia in children2097.7Growth disorders2117.8Hypocalcaemia in .11Hypopituitarism2147.12Hypothyroidism, congenital2157.13Hypothyroidism in older children and , graves disease2177.15Obesity2187.16Disorders of puberty220x