Guidelines
55 entriesNDoH Hospital-level adult STG
- AbbreviationsStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Abscess, PeritonsillarStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- AcknowledgementsThis edition of the Adult Hospital Level Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) is evidence of the dedication, technical expertise, skills, and considerable time offered by the combined PHC/Adult Hospital Level Expert Review Committee (ERC) and the National Essential Medicines List Committee (NEMLC). The ERC has enthusiastically evolved with the EML review process→
- AcneStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Acquired Coagulation Defects: Disseminated Intravascular CoagulationDescription General Measures Medicine Treatment D65/D68.2/D68.8 DESCRIPTION DIC is a complication of an underlying condition and is characterised by widespread activation of the clotting cascade which leads to consumption of clotting factors and platelets with generalized bleeding. No single diagnostic test, but the combination of a prolonged INR and PTT, presence of thrombocytopenia, decrea→
- AcromegalyStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Acute Coronary SyndromesSee: ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI) and Unstable angina (UA) . Click here for the pdf . Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_June 2024 Chapter 20: Emergencies and Injuries→
- Acute Coronary SyndromesStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Acute Kidney InjurySee Acute kidney injury . Click here for the pdf . Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_June 2024 Chapter 20: Emergencies and Injuries→
- Acute Kidney InjuryStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Additional InformationAdditional Information→
- Adrenal InsufficiencyIntroduction Relative Adrenal Insufficiency Addisonian crisis Introduction See: Adrenal insufficiency (Addison Disease) . Relative Adrenal Insufficiency ICD-10 code: E27.4/E27.9 Description This is a transient, disproportionate reduction of glucocorticoids in relation to the severity of stress. Note that absolute cortisol levels may be normal. The prevalence of relative adrenal insufficienc→
- Adrenal Insufficiency (Addison Disease)Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Adult VaccinationRabies vaccination Note: As COVID vaccination recommendations are being updated regularly as new evidence emerges, please consult the latest National Department of Health vaccine policy recommendations. Vaccine Indications Comments Influenza vaccine Z25.1 - Pregnant women. - Elderly patients >65 years. - HIV-infected patients. - Patients with chronic pulmonary or cardiac conditi→
- Aggressive Disruptive Behaviour in AdultsDescription General Measures Medicine Treatment Description ICD-10 code: R45.1/45.4-8 + code(s) for underlying/comorbid condition(s) Agitation may escalate to overt aggression and often manifests with restlessness, pacing, and loud or demanding speech. Aggressive behaviour includes verbally abusive language, specific verbal threats, intimidating physical behaviour, and/or actual physical vi→
- AlcoholsEthanol poisoning Ethylene glycol poisoning Methanol poisoning ETHANOL POISONING T51.0 + (X45.99/X65.99/Y15.99) DESCRIPTION Acute poisoning usually presents with: Nausea and vomiting Depression, seizures, coma Hypoglycaemia Hypothermia Hypokalaemia Acidosis Consider other causes for the patient’s condition, including hypoglycaemia and head trauma. GENERAL MEASURES Supportive management aimed at m→
- AmenorrhoeaDescription Medicine Treatment Referral ICD-10 code: N91.0-2 DESCRIPTION Primary amenorrhoea: no menstruation by 16 years of age in the presence of secondary sexual characteristics. Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses, or for at least 6 months with irregular cycles. Investigations Body mass index. Urine pregnancy test. Pelvic ultrasound. S→
- Amoebic DysenteryDescription General measures Medicine treatment ICD-10 code: A06.0-1 DESCRIPTION Diarrhoea with blood and/or mucus due to E. histolytica . Organism must be demonstrated on a warm stool specimen with microscopy. GENERAL MEASURES Rehydration may be necessary. This should be done with oral rehydration solution (ORS) unless the patient is vomiting or profoundly dehydrated. Surgery for bowel perforati→
- AnaemiaDESCRIPTION Defined as a reduction in the absolute number of circulating red blood cells and most commonly diagnosed when the haemoglobin (Hb) concentration falls below the reference range for age and sex (Hb reference range males 13.0–17.0 g/dL; females 12.0–15.0 g/dL). The clinical features depend on the severity of anaemia, the rate at which it developed and the oxygen demands of the patient.→
- Anaemia in Critical CareDescription General Measures Medicine Treatment ICD-10 code: D64.9 Description Anaemia is common in critical illness. Anaemia results in reduced tissue oxygen delivery which may cause or worsen organ dysfunction. The underlying cause should be investigated and treated. Avoid unnecessary phlebotomy to reduce the risk of iatrogenic anaemia. The benefits of treating anaemia must always be weig→
- Anaemia in PregnancyStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition→
- Anaemia, AplasticDescription Medicine treatment Referral D60.0-1/D60.8-9/D61.0-3/D61.8-9 DESCRIPTION Pancytopenia due to a hypoplastic bone marrow. Clinical features: Pallor Purpura Petechiae Bleeding Frequent or severe infections Pancytopenia in PLHIV B23.2 + (D61.2/D61.9) Most common causes include: Direct effect of HIV. Medication (e.g. carbamazepine, valproic acid, phenytoin or pure red cell aplasia wit→
- Anaemia, Chronic DisorderDescription General Measures D63.0/D63.8 DESCRIPTION Anaemia due to chronic inflammation. This is characteristically a normochromic normocytic anaemia. Common causes of anaemia of chronic disorder include: Malignancy, e.g. haematological or solid tumours. Autoimmune disorders, e.g. rheumatoid arthritis. Chronic infections, e.g. HIV and TB. Chronic kidney disease. GENERAL MEASURES Investigate and→
- Anaemia, HaemolyticDescription General Measures Medicine Treatment Referral/Consultation D55.0-3/D55.8-9/D56.0-4/D56.8-9/D58.0-2/D58.8-9/D59.0-6/D59.8-9 DESCRIPTION Anaemia due to destruction of red blood cells. Destruction may be due to: Extracellular factors such as auto-immunity or mechanical factors, e.g. disseminated intravascular coagulation (DIC), hypersplenism, mechanical heart valves. Abnormalities of the→
- Anaemia, Iron DeficiencyDescription General Measures Medicine Treatment Referral/Consultation D50.0-1/D50.8-9 DESCRIPTION Anaemia due to iron deficiency. Common causes of iron deficiency are chronic blood loss, poor iron absorption or poor nutritional intake. Investigations Low MCV and low MCH (mean corpuscular hemoglobin <26 pg) – note that these are often normal in early stages. Full blood count (FBC) and periphera→
- Anaemia, MegaloblasticDescription General measures Medicine treatment D51.0-2/D51.2/D51.8-9/D52.0-1/D52.8-9/D53.1/D53.8-9 DESCRIPTION Anaemia caused by a deficiency of folate and/or vitamin B 12 . Note that several medicines can cause macrocytic anaemia (e.g. hydroxyurea, methotrexate, zidovudine, azathioprine, valproic acid, and phenytoin) without deficiencies of folate and/or vitamin B 12 . Clinical manifestations o→
- Anaemia, Sickle CellDescription Vaso-Occlusive Episodes General Measures Medicine Treatment Referral D57.0-3/D57.8 DESCRIPTION Sickle cell disease (SCD) is a genetic, inherited condition resulting in abnormal red blood cells. Homozygous SCD is the commonest and most severe form, characterised by recurrent vaso-occlusive episodes (“sickle crises”) and chronic haemolytic anaemia. Adults develop hyposplenism, predispos→
- Anaesthesia, EpiduralStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Anaesthesia, GeneralStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Anaesthesia, Spinal (Intrathecal)Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Anaesthesia, TopicalStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Anaesthesiology and Intensive Care, IntroductionStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Analgesia for Acute Non-Surgical PainStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Analgesic PoisoningParacetamol poisoning Salicylate poisoning Opioid poisoning PARACETAMOL POISONING T39.1 + (X40.99/X60.99/Y10.99) DESCRIPTION Liver damage, due to the depletion of glutathione and accumulation of toxic metabolites, can occur in any individual with paracetamol overdose. Patients with predisposing risk factors for hepatotoxicity (“high risk” patients, see below) may experience toxicity at lower inge→
- Anaphylaxis/ Anaphylactic ShockDescription General measures Medicine treatment ICD-10 code: T78.2 + Y57.9 DESCRIPTION An acute, potentially life-threatening hypersensitivity reaction. The reaction usually starts within seconds to minutes after administration of, or exposure to a substance to which the individual has been sensitised. Clinical manifestations range from mild urticaria and angioedema to upper airway obstruction, b→
- Androgen DeficiencyStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- AngioedemaDescription General measures Medicine treatment ICD-10 code: T78.3 + Y57.9 Contact the 24/7 South African Angioedema Hotline at: 082 091 5684 if you require assistance with acute management, investigation or follow up. DESCRIPTION Two major groups of angioedema should be differentiated: allergic angioedema forming part of a systemic reaction to an allergen, and non-allergic angioedema caused by b→
- Anticoagulant (Warfarin and Rodenticide Superwarfarin) PoisoningDescription General measures Medicine treatment T45.5 + (X44.99/X64.99/Y14.99) * Notifiable condition – rodenticide superwarfarin poisoning Poisoning from all pesticides (i.e. agricultural stock remedies) is a notifiable medical condition. Please visit https://nicd.ac.za/nmc-overview/notification -process for further information. DESCRIPTION Poisoning due to ingestion of warfarin and superwarfari→
- Antifibrinolytic MedicationDescription Medicine Treatment Description Tranexamic acid is an antifibrinolytic agent that acts by inhibiting the activation of plasminogen, an enzyme responsible for fibrinolysis. Tranexamic acid may be considered in the following settings: Adjunctive medication in the prevention and treatment of bleeding. Where viscoelastic testing shows evidence of hyperfibrinolysis. Medicine Treatment Sever→
- Antimicrobial MedicinesStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Antimicrobial StewardshipAntimicrobial stewardship refers to a systematic approach to optimising the appropriate use of an antibiotic to improve patient outcome(s) and limit emergence of resistant pathogens, whilst ensuring patient safety. It is one arm of the national and international response to the increasing public health crisis of antibiotic resistance. A critical component is adequate infection control. Antibiotic→
- Antiretroviral Agents PoisoningDescription General measures Treatment T37.5 + (X44.99/X64.99/Y14.99) DESCRIPTION Limited data is available regarding overdose of these medicines. Toxicological effects are generally extensions of adverse effects. GENERAL MEASURES Monitor FBC, serum electrolytes, renal and liver function. Monitor serum lipase in patients with abdominal pain. Lactic acid and serum pH should be monitored in acidoti→
- Antiretroviral TherapyPlease click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using. Click here to access the Adult Hospital Level Chapter 10: HIV_and_AIDS_with_supporting_NEMLC_Report_Reviews_2025-9-Versio→
- Anxiety And Obsessive-Compulsive DisordersDescription General measures Medicine treatment Referral ICD-10 code: F40.0-2/F40.8-9/F41.0-3/F41.8-9/F42.0-9 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8) Description Anxiety is an emotional response to a perceived or anticipated stress. It is diagnosed as a disorder when it is excessive or persistent and impacts daily functioning. Anxiety disorders often present with medically une→
- Appendix 23.I: Management of VentilationInitiation of Ventilation Titration of Ventilation Weaning of Ventilation Initiation of Ventilation Once a patient has been intubated and is appropriately sedated, the ventilator is set as follows: Select the level of support: Assist-Control: Pressure Control or Volume Control The ventilator delivers the same breath during every inspiration, whether initiated by the ventilator or by the patient.→
- Appendix 23.II: Family Meeting FormClick on the image to enlarge Click here for the appendix pdf Click here for the circular Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 23: Adult Critical Care_NEMLC Medicine Recommendations Review Cycle_ 2020_2023→
- Appendix VI Devices for Respiratory Conditions Inhaler DevicesSpacer Devices Metered Dose Inhalers (MDIs) Dry Powder Inhalers (DPIs) Nebulisers References SPACER DEVICES Spacers are vital for an adequate therapeutic effect of inhaled therapy. Spacer devices should be used for all inhaled medications in all age groups to improve efficacy of medicine delivery and limit adverse effects. Use a spacer that is appropriate for the patient’s age. Infants <→
- Appendix VII: Cardiovascular Risk AssessmentStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Arthritis, Rheumatoid (RA)Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→
- Arthritis, Septic and Osteomyletitis, AcuteStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition→