Updated Guidelines for Infections and Related Conditions in Primary Healthcare
The National Department of Health has released updated guidelines for managing infections and related conditions in primary healthcare settings. The guidelines cover treatment recommendations for conditions such as shingles, schistosomiasis, and tick bite fever, emphasizing the importance of accurate diagnosis and appropriate management at the primary care level.
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Chapter 10: Infections & related conditions NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2018 1
EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http://www.health.gov.za/index.php/standard-treatment-guidelines-and- essential-medicines-list/category/285-phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2
Shingles (herpes zoster) DESCRIPTION Dermatomal eruption of vesicles on an erythematous base due to varicella zoster virus CHANGES SHINGLES guideline ADDED (previously only in HIV chapter) Pain management (paracetamol & tramadol for severe cases) & amitriptyline for post herpetic neuralgia REASON Condition commonly presents at primary level of care 3
Schistosomiasis (bilharzia) DESCRIPTION Parasitic infestation with either Schistosoma haematobium (bladder and renal tract), or Schistosoma mansoni (intestinal tract) Infestation occurs during washing, bathing or paddling in water harbouring snails shedding this parasite CHANGES Retreatment of schistosomiasis with repeated doses of praziquantel in persistent bleeding requires referral REASON Diagnosis to be verified through laboratory tests 4
Tick bite fever DESCRIPTION Tick-borne infection due to Rickettsia conorii (from dogs) or Rickettsia africae (from cattle and game) Classic triad of fever, eschar and rash occurs in 50- 75% of patients. CHANGES new STG Azithromycin, oral 10 mg/kg daily for 3 days recommended for children < 45 kg ADDED Doxycycline 100 mg daily for 3 days for children 45 kg and adults ADDED REASON Condition is common & easily managed at PHC level Azithromycin is effective & safe to use for children with mild to moderate tick bite fever Cut-off of 45 kg used aligned with international guidelines 5
