Table Of ContentRepublic of Ghana
Standard Treatment
Guidelines
Ministry of Health
Sixth Edition, 2010
© 2010 Ministry of Health (GNDP) Ghana
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording and/or otherwise, without prior
written permission of the Ministry of Health, Ghana
st
Essential Drugs List & National Formulary with Therapeutic Guidelines, 1
Edition, 1988
nd
Essential Drugs List & National Formulary with Therapeutic Guidelines, 2
Edition, 1993
rd
Essential Drugs List & National Formulary with Therapeutic Guidelines, 3
Edition, 1996
Standard Treatment Guidelines, 4th Edition, 2000
Standard Treatment Guidelines, 5th Edition, 2004
Standard Treatment Guidelines, 6th Edition, 2010
ISBN 978-9988-1-2538-7
For all enquiries write to the publishers:
Ghana National Drugs Programme (GNDP)
Ministry of Health
P. O. Box MB-582, Accra, Ghana, West Africa
Tel: (0)30 2661 670/1
Fax: (0)30 2664 309
E-mail:
LIST OF TABLES
Table 2-1: Assessment of the degree of dehydration in children with diarrhoea
Table 2-2: Treatment by Fluid therapy- Plan A
Table 2-3: Treatment by Fluid therapy- Plan B
Table 2-4: Treatment by Fluid therapy- Plan C
Table 2-5: Helicobacter pylori Eradication Therapy
Table 5-1: Pain Management in the Sickle Cell Patient
Table 6-1: Schedule for Immunization for Children
Table 8-1: Antihypertensive Treatment by Drug Class
Table 8-2: New York Heart Association functional Classification for Heart Failure
Table 10-1: Drug Treatment of Seizures
Table 10-2: Guidelines for the Management of the Unconscious Patient
Table 12-1: Guidelines for the Treatment of Itching of specific causes
Table 13-1: Regime for managing Diabetic Ketoacidosis in Adults
Table 13-2: Regime for managing diabetic Ketoacidosis in Children
Table 13-3: Example of Sliding Scale Chart
Table 15-1: Misoprostol Dosages for Reproductive Health
Table 16-1: Classification for Acute Kidney Injury, based on modification of
RIFLE criteria
Table 16-2 : Causes of Male Infertility
Table 16-3: Symptoms and Signs of Urinary Tract Calculi
Table 16-4: Distinguishing between Torsion and Epididymoorchitis
Table 19-1: Guidelines for the Treatment of the Patient with Fever
Table 19-2: Empirical Antibiotic Therapy for suspected Bacterial Meningitis in Adults
Table 19-3: Artesunate + Amodiaquine Co-Blistered Tablets (Regimen for once daily
dosing)
Table 19-4: Artesunate and Amodiaquine Co-Blistered Tablets (Regimen for twice
daily dosing)
Table 19-5: Artesunate and Amodiaquine Fixed Dose Combination.
(Standard Regimen, using the 3 available dosing strengths)
Table 19-6: Artemether and Lumefantrine (Recommended Dosing Regimen)
Table 19-7: Dihydroartemisinin and Piperaquine (Recommended Dosing Regimen)
Table 19-8: Dosing Regimen for Quinine IM Injection in young Children
Table 19-9: Rectal Artesunate (Pre-Referral Treatment in Children)
Table 19-10:Rectal Artesunate (Pre-Referral Treatment in Adults)
Table 19-11:Pharmacological Treatment of Worm Infestations
Table 20-1: Dose of Vitamin A for Xerophthalmia
Table 20-2: Characterising Acute Red Eye with no history of Injury
Table 20-3: Summary of the Common Causes and Management of Conjunctivitis
Table 23-1: Points of distinction between Inflammatory and Mechanical Back Pain
Table 24-1: Indication for use of Rabies Immunoglobulin and Rabies vaccine
Table 26-1: Choice of Antibiotic for Prophylaxis
vii
PREFACE
Standard Treatment Guidelines (STG) are systematically developed
statements that assist prescribers in deciding on appropriate treatments for
specific clinical problems. They usually reflect the consensus on the optimal
treatment options within a health system and aim at beneficially influencing
prescribing behaviour at all levels of care.
Health systems, particularly in developing countries, are faced with
growing health needs on one hand and limited resources on the other. Policy
makers at various levels are therefore engaged in designing cost-effective
health interventions that ensure accessible and affordable quality care for
all, in particular the poor and vulnerable groups.
Inappropriate prescribing is one of the manifestations of irrational
medication use behaviour. It occurs when medicines are not prescribed in
accordance with guidelines that are based on scientific evidence to ensure
safe, effective, and economic use. STGs provide the tool for health care
providers to give quality standardised care at affordable cost.
For our growing National Health Insurance Scheme, a standard
treatment guideline is seen as a cost containment tool to ensure that
inefficiencies, fraud and poly-pharmacy, often associated with Health
Insurance Schemes, are minimised.
Regular, objective and transparent reviews of STGs are very important
because the development process is a continual effort and not limited to a
one-time production. This process includes gaining acceptance of the
concept and preparing the text for wide consultation and consensus
building. This is to ensure that users identify with and collectively own the
process of development.
This document is the sixth edition of the Ministry of Health's officially
approved prescribers' and dispensers' guide for all levels of healthcare.
Great effort has been put into aligning the prevailing health insurance
benefits package to this edition.This edition is also available on compact disk
and can be accessed on the internet at www.ghndp.org.
The Ministry of Health is particularly grateful to its development
partners for their continuous support for the health sector.
I am confident that all users of this document would find this edition
very useful.
Dr. Benjamin Kunbuor
Hon. Minister for Health
May, 2010
viii
IMPORTANT CONTACTS
• PHARMACOVIGILANCE UNIT, FOOD AND DRUGS BOARD
Adverse drug reactions: Please report any adverse drug reactions to
the Pharmacovigilance Unit of the Food and Drugs Board (FDB).
Telephone number: 030- 2229 621, 030-2233 200, 030-2235 100,
030-2225 502
Fax number: 030- 2229 794
Website: www.fdbghana.gov.gh
• NATIONAL AIDS CONTROL PROGRAMME (NACP)
Telephone number: 030-2662 691
• NATIONAL AMBULANCE SERVICES
Telephone number: 030-2684 201, 030-2684 251, 030-2684 259
• NATIONAL DRUG INFORMATION RESOURCE CENTRE
Telephone number: 030-2678 557, 030-2678 559
Fax number: 030-2678 557
Website: www.ghanadruginformation.org
• NATIONAL POISONS CONTROL CENTRE
Telephone number: 030-2238 636, 030-2243 552
• NATIONAL BURULI ULCER CONTROL PROGRAMME
Telephone number: 030-2686 337
Fax number: 030-2686 336
Website: www.burulighana.org
• GHANA POLICE SERVICE
Telephone number: 191, 999, 027-7522 288
Website: www.ghanapolice.info
Comments and suggestions should be sent to:
The Programme Manager
Ghana National Drugs Programme
Ministry of Health
P.O. Box MB-582, Accra, Ghana
Telephone number: (0) 30 2661 670/1
Fax number: (0) 30 2664 309
E-mail:
ACKNOWLEDGEMENT
The review of the Standard Treatment Guidelines 2010 by the Ministry of
Health / Ghana Health service and its agencies has been successfully
completed as a result of the recommendations and contributions received
from:
MOH/GHS/School of Medicine and Pharmacy Executives
Dr. B. Kunbuor Hon. Minister of Health
Dr. Elias K. Sory Director General, Ghana Health
Service (GHS)
Dr. Sylvester D. Anemana Ag. Chief Director, MOH
Mr. James Ohemeng Kyei Chief Pharmacist, GHS/MOH
Mr. George Dakpalah Director, Policy Planning Monitoring
and Evaluation (PPME), MOH
Mr. Samuel Boateng Director, Ministry of Health (MOH)
Dr. Cynthia Bannerman Institutional Care Division, GHS
Mrs. Freda Bartels Mensah Ag. Director, Procurement and Supplies,
MOH.
Mr. Sylvester Mensah CEO, National Health Insurance Authority
Dr. Akwasi Osei Chief Psychiatrist, GHS
Dr. (Mrs.) G. Quansah Asare Director, Family Health, GHS
Prof. Nii Otu Nartey CEO, Korle Bu Teaching Hospital (KBTH)
Prof. Ohene Adjei CEO, Komfo Anokye Teaching Hospital
(KATH)
Prof. (Mrs.) C. Ntim Amponsah Dean, University of Ghana Medical School
(UGMS)
Prof. Kwabena Danso Dean, School of Medical Sciences (SMS),
Kwame Nkrumah University of Science
and Technology (KNUST)
Prof. Mahama Duwiejua Dean, Faculty of Pharmacy and
Pharmaceutical Sciences, KNUST
Mrs. Joycelyn Azeez Head, Procurement Unit, MOH
Mr. Peter Ekow Gyimah Head, Central Medical Stores, MOH
Expert Committee Members
Dr. F. Ofei (Chairman) Department of Medicine and
Therapeutics, UGMS
Dr. K. Aboah Department of Surgery, SMS, KNUST
Dr. A. Akpalu Department of Medicine, KBTH
Mr. P. Anum National Drugs Information Centre,
Pharmacy Council
Dr. K. Aryee Department of Obstetrics and
Gynaecology, UGMS
Dr. J.N. Clegg-Lamptey Department of Surgery, UGMS
Dr. A.N.O. Dodoo Centre for Tropical Clinical Pharmacology
and Therapeutics, UGMS
Dr. (Mrs.) I. Ekem Department of Haematology, UGMS
x
ACKNOWLEDGEMENTS
Dr. (Mrs.) A. Forson Department of Medicine and
Therapeutics, UGMS
Prof. E. H. Frimpong Department of Medical Microbiology,
SMS, KNUST
Dr. E. D. Kitcher Department of Surgery, UGMS
Prof. G. Klufio Department of Surgery, UGMS
Prof. M. O. Mate-Kole Department of Medicine and
Therapeutics, UGMS
Mr. A. Mensah Department of Pharmacy, KATH
Prof. S. Naaeder Department of Surgery, UGMS
Mrs. Amah Nkansah Department of Pharmacy, KBTH
Prof. H. Addo Department of Medicine and
Therapeutics, UGMS
Dr. (Mrs.) E. Ofori-Adjei University Health Services, University of
Ghana
Dr. S. Ohene Department of Psychiatry, UGMS
Dr. I. Owusu Department of Medicine, SMS, KNUST
Prof. (Mrs.) B. Quarm Goka Department of Child Health, UGMS
Mr. R. Tetteh Department of Pharmacy, KBTH
Prof. (Mrs.) J. Welbeck Department of Child Health, UGMS
Editorial Committee Members
Dr. F. Ofei (Chairman) Department of Medicine and
Therapeutics, UGMS
Dr. A. Akpalu Department of Medicine, KBTH
Dr. A.N.O. Dodoo Centre for Tropical Clinical Pharmacology
and Therapeutics, UGMS
Mrs. Martha Gyansa-Lutterodt Ghana National Drugs Programme, MOH
Mrs. Amah Nkansah Department of Pharmacy, KBTH
Prof. (Mrs.) J. Welbeck Department of Child Health, UGMS
Coordinators
Mrs. Augustina Koduah Ghana National Drugs Programme, MOH
Mr. Brian Adu Asare Ghana National Drugs Programme, MOH
Programme Managers
Dr. P. Aboagye Reproductive Health Unit, GHS
Dr. N.A. Addo National AIDS/STI Control Programme
(NACP)
Dr. K.O. Antwi-Agyei Expanded Programme on Immunization
(EPI), GHS
Dr. (Mrs.) C. Bart-Plange National Malaria Control Programme
(NMCP), GHS
Dr. F. Bonsu National Tuberculosis Programme.
(NTP), GHS
xi
ACKNOWLEDGEMENTS
Dr. O. Debrah Eyecare Programme, GHS
Dr. Agana Nsiire National Yaws Eradication Programme
(NYEP)
Dr. S. Kyei Faried Head, Disease Control Unit, GHS
Dr. (Mrs.) I. Sagoe-Moses Child Health, GHS
Dr. Yaa Osei Family Planning, GHS
World Health Organisation (WHO)
Dr. Daniel Kertesz Country Representative, Ghana
Mrs. Edith Andrews-Annan National Professional Officer, Essential
Drugs and Medicines Policy, Ghana
Management Sciences for Health
Mr. Kwesi Eghan Country Representative, MSH/SPS/USAID
Ghana National Drugs Programme
Mrs. Martha Gyansa-Lutterodt Programme Manager
Mrs. Augustina Koduah Assistant Programme Manager
Mr. Brian Adu Asare Programme Officer
Mrs. Stella A. Ntow Principal Programme Accountant
Mr. Joshua Y. Quarshie Accountant
Agnes Osei Konadu Account Officer
Mrs. Mispah Afram Office Manager
Diana Edusei Front Desk Manager
The Royal Netherlands Government
for their support to the Ghana National Drugs Programme (GNDP)
GNDP Steering Committee
Mr. Robert Joseph Mettle-Nunoo Hon. Deputy Minister, Ministry of Health
Dr. Sylvester D. Anemana Ag. Chief Director, MOH
Dr. Elias K. Sory Director General, GHS
Mr. James Ohemeng Kyei Chief Pharmacist, MOH/GHS
Mr. T.C.P. Corquaye Ag. Chairman, Food & Drugs Board
Mr. David Anim Addo Chairman, Pharmacy Council
Mrs. Freda Bartels Mensah Ag. Director, Procurement and Supplies,
MOH
Mr. F. Dakpallah Director, PPME, Ministry of Health
Prof. David Ofori-Adjei University of Ghana Medical School
Mr. Herman Dusu Financial Controller, MOH
Dr. (Mrs.) I. Agyepong Regional Director of Health Services,
Greater Accra Region
Prof. Mahama Duwiejua Dean, Faculty of Pharmacy and
Pharmaceutical Sciences, KNUST
Mrs. Martha Gyansa-Lutterodt Programme Manager, GNDP/MOH
xii
CHAPTER 1: INTRODUCTION
The Government of Ghana, through the National Drug Policy, remains
committed to ensuring the availability of, and accessibility to affordable and
good quality medicines for all Ghanaians; and it is expected that these
medicines would be used rationally. Achieving these objectives require a
comprehensive strategy that, not only includes supply and distribution, but
also appropriate and thoughtful prescribing, dispensing and use of
medicines.
The Ministry of Health since 1983 has been publishing a list of Essential
Drugs with Therapeutic Guidelines to aid the rational use of drugs. This
document has been reviewed in response to new knowledge on drugs and
diseases and changes in the epidemiology of diseases in Ghana. The
Ministry has also produced separate guidelines for specific disease control
programmes, diseases and identifiable health providers.
The Standard Treatment Guidelines have been prepared as a tool to
assist and guide prescribers (including doctors, medical assistants, and
midwives), pharmacists, dispensers, and other healthcare staff who
prescribe at primary care facilities in providing quality care to patients. The
guidelines list the preferred treatments for common health problems
experienced by people in the health system and were subjected to
stakeholder discussions before being finalised to ensure that the opinion of
the intended users were considered and incorporated.
The guidelines are designed to be used as a guide to treatment choices
and as a reference book to help in the overall management of patients, such
as when to refer. The guidelines are meant for use at all levels within the
health system, both public and private.
It is recognised that the treatment guidance detailed in this book may
differ from the reader’s current practice. It is emphasised that the choices
described here have the weight of scientific evidence to support them,
together with the collective opinion of a wide group of recognised national
and international experts. The recommendations have been rated on the
following basis:
Evidence rating A – requires at least one randomised control trial as
part of a body of scientific literature of overall good quality and consistency
addressing the specific recommendation.
Evidence rating B – requires the availability of well-conducted clinical
studies but no randomised clinical trials on the topic of recommendation.
Evidence rating C – requires evidence obtained from expert committee
reports or opinions and/or clinical experience of respected authorities. This
indicates an absence of directly applicable clinical studies of good quality.
Treatments other than those recommended here may have to be
justified to colleagues, managers, or in law.
13
The content of these treatment guidelines will undergo a process of
continuous review. Comments or suggestions for improvement are
welcome.
Those comments or suggestions for addition of diseases should include
evidence of prevalence as well as a draft treatment guideline using the
format set out in this book. In the case of a request for a new drug or
replacing a listed product with another product, the evidence base must be
clearly defined and included with the request.
These suggestions should be sent to:
The Programme Manager
Ghana National Drugs Programme
Ministry of Health
P.O. Box MB-582, Accra, Ghana
West Africa
Website: www.ghndp.org
HOW TO USE THIS BOOK
To use these guidelines effectively, it is important that you become
familiar with the contents and layout.
The contents of this book have as much as possible been arranged in
order of 'body systems'. Within each section, a number of disease states
which are significant in Ghana have been identified. For each of these
disease states the information and guidance has been standardised to
include a brief description of the condition or disease and the more
common symptoms and signs. In each case the objectives of treatment have
been set out, followed by recommended non-pharmacological as well as the
pharmacological treatment choices.
The choice of treatment used here is based on the principles of
'evidence based medicine'. That is, it is based on the international medical
and pharmaceutical literature, which clearly demonstrates the efficacy of
the treatment choices.
The treatment guidelines try to take the user through a sequence of
diagnosis, treatment, treatment objectives, and choice of treatment and
review of outcome. It is strongly recommended that prescribers adopt a
similar approach to practice. Care should be taken to avoid symptomatic
management of uncertain diagnoses.
When treating patients, the final responsibility for the well being of the
individual patient remains with the prescriber. Prescribers must take steps
to ensure that they are competent to manage the most common conditions
14
