Standard treatment Guideline for Primary Hospital Food, Medicine and Healthcare Administration ...

642 Pages·2014·7.17 MB·English

ABOUT THIS BOOK
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The purpose of this document is to improve the quality of care patients o
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an improvement on the 2010 edition and incorporates updates in the r
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treatment and management of the diseases and illness in the previous Food, Medicine and Healthcare
edition. The scope of health problems was reviewed and added on to by a
panel of experts. Administration and Control

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t Authority of Ethiopia
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Every effort has been made to ensure accuracy of the information provided. p
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The guidelines in this book are directed at all health prescribers and have o
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built-in triggers for referral to higher care levels. The information provided

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has been checked to ensure that there is no conflict with guidelines of
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public health programmes. m
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The content of this treatment guidelines will undergo a process of
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Food, Medicine and Health Care Administration G
Clinical features
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P.O. Box: 5681,Addis Ababa, Ethiopia. e
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Tel.:- 251 552 41 22/52 41 23 Investigations Dispensing Practices
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Printed by: Third Edition, 2014
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THIRD EDITION,2014
CONTENTS
ACKNOWLEDGMENTS ........................................................................................7
ACRONYMS ........................................................................................................ 12
PREFACE ...........................................................................................................1 6
INTRODUCTION .................................................................................................1 7
CHAPTER I: GOOD PRESCRIBING AND DISPENSING PRACTICES ................ 1
CHAPTER II: CARDIOVASCULAR DISORDERS ...............................................2 3
1. Acute Cardiogenic Pulmonary Edema ............................................... 23
2. Endocarditis (Infective Endocarditis) ................................................. 25
3. Heart Failure ......................................................................................... 31
4. Hypertension ........................................................................................ 39
5. Ischaemic Heart Disease ..................................................................... 46
6. Rheumatic Fever .................................................................................. 54
CHAPTER III: ENDOCRINE DISORDERS. ......................................................... 57
1. Adrenal Insufficiency ........................................................................... 57
2. Cushing's Syndrome ............................................................................ 58
3. Diabetes Mellitus .................................................................................. 59
4. Gout ....................................................................................................... 70
5. Hypothyroidism .................................................................................... 72
6. Thyrotoxicosis ...................................................................................... 73
CHAPTER IV: GASTROINTESTINAL TRACT AND LIVER DISORDERS .......... 74
1. Constipation ......................................................................................... 74
2. Dyspepsia And Peptic Ulcer Disease ................................................. 75
3. Hemorrhoids ......................................................................................... 79
4. Hepatitis ................................................................................................ 81
5. Acute Liver Failure And Fulminant Hepatitis ..................................... 82
6. Liver Cirrhosis ...................................................................................... 83
CHAPTER V: HEMATOLOGIC DISORDERS .....................................................8 5
1. Anemia .................................................................................................. 85
2. Immune Thrombocytopenic Purpura (ITP) ......................................... 87
3. Venous Thrombo Embolism ................................................................ 88
CHAPTER VI: INFECTIOUS DISEASES ............................................................9 2
1. Acquired Immunodeficiency Syndrome (AIDS) ................................. 92
2. Amebiasis ........................................................................................... 103
3. Amebic Liver Abscess ....................................................................... 104
4. Anthrax ................................................................................................ 106
5. Bacillary Dysentery ............................................................................ 109
6. Brucellosis .......................................................................................... 111
7. Candidiasis ......................................................................................... 114
8. Cholera ................................................................................................ 118
9. Clostridium Difficille Associated Disease (CDAD) .......................... 119
10. Cryptococcosis .................................................................................. 121
11. Filariasis, Lymphatic (Elephantiasis) ............................................... 124
12. Giardiasis ............................................................................................ 128
13. Intestinal Helminthic Infestations ..................................................... 129
14. Leishmaniasis .................................................................................... 132
15. Leprosy (Hansen’s Disease) ............................................................. 139
16. Malaria ................................................................................................. 152
17. Neutropenic Fever .............................................................................. 163
18. Onchocerciasis .................................................................................. 168
19. Rabies ................................................................................................. 169
20. Relapsing Fever.................................................................................. 174
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21. Schistsomiasis ................................................................................... 176
22. Tetanus ............................................................................................... 177
23. Toxoplasmosis (CNS) ........................................................................ 180
24. Tuberculosis ....................................................................................... 182
25. Typhoid Fever ..................................................................................... 201
26. Typhus ................................................................................................ 203
27. Varicella (Chicken Pox) ...................................................................... 204
CHAPTER VII: KIDNEY and GENITOURINARY TRACT DISORDERS ............ 207
1. Acute Kidney Injury ............................................................................ 207
2. Chronic Kidney Disease .................................................................... 209
3. Electrolyte Disorders ......................................................................... 213
4. Urinary Tract Infection ....................................................................... 219
CHAPTER VIII: MUSCULOSKELETAL DISORDERS .......................................2 23
1. Osteoarthritis ...................................................................................... 223
2. Pyogenic Osteomyelitis ..................................................................... 226
3. Rheumatoid Arthritis (RA) ................................................................. 227
4. Septic Arthritis ................................................................................... 231
CHAPTER IX: NEUROLOGICAL DISORDERS ...............................................2 33
1. Meningitis ........................................................................................... 233
2. Migraine .............................................................................................. 237
3. Seizure And Epilepsy ......................................................................... 240
CHAPTER X: ONCOLOGY ...............................................................................2 46
1. Breast Cancer ..................................................................................... 246
2. Chronic Lymphatic Leukemia (CLL) ................................................. 247
3. Chronic Myelogenous Leukemia (CML) ........................................... 248
4. Colorectal Cancer ............................................................................... 249
5. Head and Neck Cancer ...................................................................... 250
6. Ovarian Cancer ................................................................................... 251
CHAPTER XI: PSYCHIATRIC DISORDERS ..................................................... 252
1. Anxiety Disorders ............................................................................... 252
2. Mood Disorders .................................................................................. 253
3. Schizophrenia ..................................................................................... 263
4. Suicide /Self-Harm .............................................................................. 266
CHAPTER XII: RESPIRATORY DISORDERS ..................................................2 69
1. Bronchitis (Acute) .............................................................................. 269
2. Bronchial Asthma ............................................................................... 273
3. Chronic Obstructive Pulmonary Disease (COPD) ........................... 279
4. Pneumocystis Carinni (P. Jiroveci) Pneumonia .............................. 283
5. Pneumonia .......................................................................................... 286
CHAPTER XIII: EMMERGENCY CONDITIONS ...............................................2 95
1. Anaphylaxis ........................................................................................ 295
2. Bites and Stings ................................................................................. 296
3. Burn ..................................................................................................... 302
4. Hypoglycemia ..................................................................................... 306
5. Near - Drowning.................................................................................. 308
6. Poisioning and Overdose .................................................................. 310
7. Shock .................................................................................................. 317
8. Stroke (Cerebrovascular Accident) .................................................. 319
9. Sudden Cardiac Arrest ...................................................................... 321
10. Upper Gastrointestinal Bleeding (Acute) ......................................... 324
CHAPTER XIV: PEDIATRIC DISORDERS .......................................................3 27
1. Acute Post Streptococcal Glomerulonephritis ................................ 327
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2. Acute Rheumatic Fever ..................................................................... 328
3. Bronchial Asthma ............................................................................... 330
4. Croup (Acute Laryngo-Tracheo-Bronchitis) .................................... 332
5. Diarrheal Disease (Acute) .................................................................. 334
6. Foreign Body Aspiration ................................................................... 339
7. Heart Failure In Children .................................................................... 341
8. HIV/ AIDS in Children ......................................................................... 343
9. Jaundice In Neonates ........................................................................ 346
10. Malnutrition (Severe) .......................................................................... 347
11. Meningitis ........................................................................................... 358
12. Nephrotic Syndrome .......................................................................... 361
13. Oral Trush ........................................................................................... 363
14. Osteomyelitis ...................................................................................... 364
15. Pertusis (Whooping Cough) .............................................................. 365
16. Pneumocystis Carini Pneumonia (PCP) ........................................... 366
17. Pneumonia In Children ...................................................................... 368
18. Rickets ................................................................................................ 370
19. Seizures (Neonatal) ............................................................................ 372
20. Sepsis (Neonatal) ............................................................................... 373
21. Tuberculosis in Children .................................................................. 375
CHAPTER XV: DERMATOLOGICAL DISORDERS ..........................................3 79
1. Acne Vulgaris ..................................................................................... 379
2. Bacterial Folliculitis ........................................................................... 381
3. Candidiasis (Candidiasis, Moniliasis, Thrush) ................................ 383
4. Carbuncle ............................................................................................ 386
5. Cellulitis .............................................................................................. 386
6. Dermatophytoses ............................................................................... 388
7. Eczema ................................................................................................ 390
8. Erysipelas ........................................................................................... 395
9. Erythema Multiforme, Stevens Johnson Syndrome, Toxic
Epidermal Necrolysis .................................................................................. 397
9.1. Erythema multiforme (EM) ................................................................. 397
9.2. Stevens Johnson Syndrome (SJS) & Toxic Epidermal
Necrolysis (TEN) .......................................................................................... 397
10. Furuncle .............................................................................................. 399
11. Herpes Simplex (HS) .......................................................................... 400
12. Impetigo .............................................................................................. 401
13. Molluscum Contagiosum .................................................................. 403
14. Pediculosis Corporis and Capitis ..................................................... 404
15. Pityriasis Versicolor (PV) ................................................................... 405
16. Psoriasis ............................................................................................. 406
17. Scabies ................................................................................................ 408
18. Urticaria ............................................................................................... 410
19. Verruca Vulgaris (Common Warts) ................................................... 412
CHAPTER XVI: SEXUALLY TRANSMITTED INFECTIONS (STI) ................... 413
SYNDROMIC MANAGEMENT OF STI .............................................................4 13
1. Urethral Discharge ............................................................................. 416
2. Persistent/Recurent Urethral Discharge .......................................... 417
3. Genital Ulcer Diseases (GUD) ........................................................... 418
4. Vaginal Discharge .............................................................................. 422
5. Lower Abdominal Pain ....................................................................... 424
6. Scrotal Swelling.................................................................................. 427
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7. Inguinal Bubo ..................................................................................... 428
CHAPTER XVII: OPHTHALMOLOGICAL DISORDERS ................................... 431
1. Acute Dacryocystitis .......................................................................... 431
2. Acute Infectious Dacryoadenitis ....................................................... 433
3. Allergic Conjunctivitis ....................................................................... 434
4. Bacterial Conjunctivitis ..................................................................... 440
5. Blepharitis ........................................................................................... 443
6. Cataract ............................................................................................... 446
7. Chemical Burns .................................................................................. 447
8. Glaucoma ............................................................................................ 448
9. Hordeolum (External) or Stye ............................................................ 451
10. Internal Hordeolum ............................................................................ 453
11. Meibomian cyst (Chalazion) .............................................................. 453
12. Molluscum contagiosum ................................................................... 454
13. Ophthalmic Zoster (Herpes Zoster Ophthalmicus=HZO) ............... 455
14. Orbital Cellulitis .................................................................................. 457
15. Preseptal Cellulitis ............................................................................. 459
16. Trachoma ............................................................................................ 461
17. Vitamin A Deficiency (Xerophthalmia) .............................................. 463
CHAPTER XVIII: EAR, NOSE AND THROAT ...................................................4 66
I. EAR ................................................................................................................4 66
1. Acute Otitis Media .............................................................................. 466
2. Bacterial and Viral Diffuse Otitis Externa ......................................... 469
3. Chronic Otitis Media .......................................................................... 471
4. Foreign Bodies In The Ear ................................................................. 473
5. Idiopathic Facial Paralysis (Bells Palsy ) ......................................... 474
6. Nonspecific Inflamation Of The External Ear ................................... 476
7. Herpes Zoster Oticus ......................................................................... 477
II. NOSE AND NASAL SINUSES ......................................................................4 79
1. Acute Rhinitis ..................................................................................... 479
2. Acute Rhino Sinusitis ........................................................................ 480
3. Allergic Rhinitis .................................................................................. 481
4. Atrophic Rhinitis And Ozeana ........................................................... 483
5. Chronic Rhinosinusitis ...................................................................... 483
6. Epistaxis ............................................................................................. 485
7. Nasal Furuncle.................................................................................... 487
8. Foreign Bodies In The Nose .............................................................. 488
III. MOUTH AND PHARYNX .............................................................................4 89
1. Acute Tonsillitis.................................................................................. 489
IV. SALIVARY GLANDS ....................................................................................4 91
1. MUMPS (Epidemic Parotitis) ............................................................. 491
CHAPTER XIX: GYNACOLOGY AND OBSTETRICS ....................................... 492
A. COMMON OBSTETRIC DISORDERS IN PREGNANCY ........................... 492
1. Hypertensive Disorders In Pregnancy .............................................. 492
2. Hyperemesis Gravidarum .................................................................. 499
3. Pain During Labour And Delivery ..................................................... 502
4. Post-Partum Haemorrhage (PPH): Prevention And Management .. 504
5. Premature Rupture Of Membranes (PROM) ..................................... 508
6. Preterm Labour .................................................................................. 511
7. Prolonged Pregnancy And Prolonged Labour................................. 514
B. COMMON MEDICAL DISORDERS IN PREGNANCY ...............................5 18
1. Anemia In Pregnancy ......................................................................... 518
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2. Jaundice In Pregnancy ...................................................................... 519
3. Cardiac Diseases In Pregnancy ........................................................ 522 ACKNOWLEDGMENTS
4. Deep Vein Thrombosis/Thromboembolism (DVT/TE) In
Pregnancy .................................................................................................... 525
5. Diabetes Mellitus Complicating Pregnancy ..................................... 527 The Ethiopian Food, Medicine and Healthcare Administration and Control
6. Thyroid Diseases In Pregnancy ........................................................ 532
Authority (EFMHACA) would like to extend its sincere appreciation to
7. HIV/AIDS in Pregnancy ...................................................................... 535
8. Malaria In Pregnancy ......................................................................... 541 USAID/SIAPS for its technical and financial assistance for the revision of
9. Urinary Tract Infection In Pregnancy ................................................ 544
these standard treatment guidelines. The Authority would like also to thank
10. Syphilis In Pregnancy ........................................................................ 547
C. COMMON GYNECOLOGIC DISORDERS ................................................. 549 the consulting firm, Bethel teaching hospital, for its commitment to complete
1. Pelvic Inflammatory Diseases (PID) .................................................. 549
2. Puerperal Mastitis .............................................................................. 552 this important task.
3. Vaginal Discharge Syndromes .......................................................... 553
4. Abortion .............................................................................................. 560
5. Abnormal Uterine Bleeding (AUB) .................................................... 570 We would also like to give special acknowledgement to the STG Core group,
6. Dysmenorrhoea .................................................................................. 573
FMHACA task force and the expert group members for their unreserved
7. Menopause And Perimenopausal Syndrome hormone .................. 575
8. Carcinoma Of The Cervix .................................................................. 578 effort to bring this document to reality.
9. Gestational Trophoblastic Diseases (GTD) ...................................... 581

D. HORMONAL CONTRACEPTIVES .............................................................5 85
E. SEXUAL ASSAULT ....................................................................................5 88 Last but not least, the Authority would also like to recognize and
ANNEXES .........................................................................................................5 90
INDEX ............................................................................................................ 616 acknowledge the contribution of all participants of the consultative

workshops and all editors for their invaluable contributions in scrutinizing and

finalizing this document.

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ACKNOWLEDGMENTS

The Ethiopian Food, Medicine and Healthcare Administration and Control
Authority (EFMHACA) would like to extend its sincere appreciation to
USAID/SIAPS for its technical and financial assistance for the revision of
these standard treatment guidelines. The Authority would like also to thank
the consulting firm, Bethel teaching hospital, for its commitment to complete
this important task.

We would also like to give special acknowledgement to the STG Core group,
FMHACA task force and the expert group members for their unreserved
effort to bring this document to reality.

Last but not least, the Authority would also like to recognize and
acknowledge the contribution of all participants of the consultative
workshops and all editors for their invaluable contributions in scrutinizing and
finalizing this document.

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Contributors and editors of the 3rd edition of the STG v. Task Force Members(Coordinators)

Mr. Mengsteab Wolde Aregay Deputy Director General,
i. Food, Medicine and Health Care Administration and Control
FMHACA
Authority (FMHACA)
Mr. Kidanemariam GebreMichael Task Force Chair Person,
FMHACA
ii. Consultant Mr. Ajema Bekele Pharmacist, Task Force
Secretery, FMHACA
Bethel Teaching Hospital
Mrs. Seble Shambel Pharmacologist, FMHACA
iii. STG Core Team Mr. Hailu Tadeg Deputy Chief of Party, USAID/SIAPS
Mr. Edmealem Ejigu Senior Technical Advisor, USAID/SIAPS
Prof. Eyasu Makonnen Pharmacologist (Chairperson)

Dr. Kassahun Kiros Gynacologist
Dr. Yilikal Adamu Ophthalmologist vi. Editors
Dr. Yewondwossen Tadesse Internist
Dr. Alemayehu Keno Pharmacologist (Secretary) Mr. Edmealem Ejigu
Mr. Ajema Bekele
iv. Experts Mrs. Seble Shambel
Mr. Kidanemariam G/Michael
Dr. Addisu Melkie Internist Miss Raey Yohannes (Pharmacologist)
Dr. Endale Teferra Pediatrician
Dr. Mathewos Assefa Oncologist
Dr. Eshetu Kebede Public Health Specialist
Dr. Seble FikreMariam Pediatrician

Dr. Admassu Tenna Infectious Disease Specialist

Dr. Girma Tesema ENT Specialist

Dr. Solomon Worku Dermatologist

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v. Task Force Members(Coordinators)

Mr. Mengsteab Wolde Aregay Deputy Director General,
FMHACA
Mr. Kidanemariam GebreMichael Task Force Chair Person,
FMHACA
Mr. Ajema Bekele Pharmacist, Task Force
Secretery, FMHACA
Mrs. Seble Shambel Pharmacologist, FMHACA
Mr. Hailu Tadeg Deputy Chief of Party, USAID/SIAPS
Mr. Edmealem Ejigu Senior Technical Advisor, USAID/SIAPS

vi. Editors

Mr. Edmealem Ejigu
Mr. Ajema Bekele
Mrs. Seble Shambel
Mr. Kidanemariam G/Michael
Miss Raey Yohannes (Pharmacologist)

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