Guidelines
314 entriesNDOH Standard Treatment Guidelines and clinical protocols
- Circular 16 March 2026: Update to the Dinoprostone Vaginal Gel Stock Constraints and Proposed Therapeutic AlternativesThis is an update to the previous circular: Dinoprostone Vaginal Gel; 1 mg/3g; Prefilled Syringe Stock Supply Shortage and the Proposed Therapeutic Alternatives (Reference: 20260227/EDP01). The Adult Hospital Level (AHL) Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) currently recommends dinoprostone vaginal gel as a treatment option for labour induction for an unfavourabOther→
- Circular 17 June 2021: Dolutegravir in Pregnant Women and Women of Child-bearing Potential (WOCP)The risk of neural tube defects in infants exposed to dolutegravir in early pregnancy that was first identified in the Tsepamo observational study in Botswana has diminished over time, with the accumulation of further data. The risk difference between dolutegravir and efavirenz is no longer significant. Dolutegravir (especially when combined with tenofovir alafenamide) is associated with more weiOther→
- Circular 17 October 2024: Analogue insulin - EML status and AnnexuresAs communicated in previous circulars: (1) Availability of Insulin Pen Sets dated 06 May 2024 and (2) Guidance on insulin switching insulin pen sets to insulin vials, and human insulin products to insulin analogue products; there have been significant challenges in accessing human insulin pen sets. Click here for the pdf .Other→
- Circular 17 October 2024: Ultra-Fast-Acting and Long-Acting Insulin Analogue Interim Essential Medicines List StatusAs communicated in previous circulars: (1) Availability of Insulin Pen Sets dated 06 May 2024 and (2) Guidance on insulin switching insulin pen sets to insulin vials, and human insulin products to insulin analogue products; there have been significant challenges in accessing human insulin pen sets. Click here for the circular .Other→
- Circular 17 September 2025: Notice - Unfractionated Heparin Stock ConstraintsSouth Africa faces an imminent shortage of unfractionated heparin (UFH) injections, a critical medication for various medical conditions. The sole supplier, Fresenius Kabi, has been ordered by the South African Health Products Regulatory Authority (SAHPRA) to halt production, with existing supplies expected to last only four to five months. This manufacturing pause creates a significant risk of sOther→
- Circular 18 December 2024: Criteria for Emicizumab use as Routine Prophylaxis in the Management of Patients with Haemophilia A with Factor VIII InhibitorsThe National Essential Medicines List Committee (NEMLC) has approved the inclusion of emicizumab as routine prophylaxis to prevent bleeding or reduce the frequency of bleeding episodes in adults and children with severe haemophilia A (congenital factor VIII deficiency) with factor VIIl inhibitors, as a special access medicine on the Tertiary and Quaternary Level Essential Medicines List (EML). ¹Other→
- Circular 18 December 2025: Notice - Update to the Guidance on Isoniazid Preventive Therapy (IPT) in PregnancySubsequent to publication of the consensus recommendation for the use of IPT in pregnant women (communication dated 6 December 2025), clinicians raised concerns about deferring IPT until after delivery in pregnant women with advanced HIV, who are at highest risk of developing active tuberculosis. This has prompted a revision of the guidance issued. Click here to access the pdfOther→
- Circular 19 June 2025: National Essential Medicines List Committe (NEMLC) BulletinAccess to the Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) has never been more convenient, thanks to several digital platforms supported by the National Department of Health (NDoH). The most up-to-date versions of the STGs and EML can be found on the NHI website . This portal houses documents tailored to each Level of Care, along with related technical resources.Other→
- Circular 22 January 2025: Anastrozole Availability and Therapeutic AlternativeThe Tertiary and Quaternary Essential Medicines List (EML) recommends the use of the aromatase inhibitors for the management of adjuvant and metastatic breast cancer. The aromatase inhibitors recommended are: anastrozole, letrozole and exemestane. See table below outlining the NEMLC recommendation. Click here to access the circular .Other→
- Circular 23 March 2026: Rifabutin 150mg Capsules Supply Constraints – Interim Therapeutic AlternativesThe Primary Healthcare (PHC) and Adult Hospital Level (AHL) Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) currently recommend the use of rifabutin 150mg capsules for select indications in the management of TB disease and mycobacterium avium complex infection. There is a reported supply constraint with rifabutin 150mg capsules. The Affordable Medicines Directorate has iniOther→
- Circular 24 March 2026: Publication of the NEMLC Approved Updates to the PHC, AHL and PHL Chapters for the STGs and EML: 2025 - 2029 Review CycleIn this notice find the list of the recently published 2026 chapter updates to previous editions of the PHC, AHL and PHL STGs and EML. Updates to chapters and supporting technical documents (medicine reviews, costing reports, NEMLC reports, implementation slides for PHC level) for the 2025-2029 review cycle are uploaded onto the National Health Insurance (NHI) webpage following finalisation for pOther→
- Circular 27 February 2025: National Essential Medicines List Committee (NEMLC) BulletinAccess to the Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) has never been more convenient, thanks to several digital platforms supported by the National Department of Health (NDoH). The most up-to-date versions of the STGs and EML can be found on the NHI website . This portal houses documents tailored to each Level of Care, along with related technical resources. For heOther→
- Circular 27 February 2026: Availability of Nevirapine 50mg/ 5ml Suspension 100ml and 240mlNevirapine (NVP) suspension, together with zidovudine (AZT) syrup, is indicated for infants as part of the Prevention of Mother to Child Transmission (PMTCT) programme. There is currently a shortage of NVP 50mg/5ml suspension. The shortage has arisen due to manufacturing constraints reported by the suppliers, which have resulted in delayed production and limited availability of stock. Although thOther→
- Circular 27 March 2025: National Essential Medicines List Committe (NEMLC) BulletinThe following formats of the STGs and EML are accepted by the National Department of Health (NDoH): NHI website (latest version of the STGs and EML): The STGs and EML can be accessed by clicking here . Click on the relevant tab to access the STGs, EMLs and technical documents for each Level of Care. Refer to Annexure A for guidance on how to navigate the website and access the relevant documents.Other→
- Circular 29 April 2026: Non-availability of Ethambutol 400mg TabletsThe availability of ethambutol 400 mg tablets is currently constrained. Although the Affordable Medicines Directorate (AMD) has identified a supplier willing to supply the tablets; deliver is only expected around mid‑May 2026. The existing ethambutol stock is due to expire at the end of April 2026. As there may be reluctance to issue medicines expiring within a month, the Cluster: Tuberculosis (TOther→
- Circular 29 July 2025: Primary Healthcare and Adult Hospital Level Errata - eGFR Monitoring Intervals for Patients on Tenofovir Disoproxil Fumarate (TDF)Kindly note that the complete editions of the 2024 PHC (8th edition) and the AHL (6th edition) STGs and EMLs are now published on the National Department of Health website at: https://www.health.gov.za/nhi-edp-stgs- eml/ . The complete editions replace the PHC (2020) and AHL (2019) versions. Additionally, please note the corrections to the individually published versions of the PHC Chapter 11: HIOther→
- Circular 3 April 2025: Interruption in the Supply of Betamethasone Disodium Phosphate 4mg/ml InjectionThis is an update to the published circular ref: CMU 04/2025 disseminated on 26 February 2025, see Annexure 1. The circular update outlines the Standard Treatment Guidelines (STG) alternatives Betamethasone Disodium Phosphate; 4mg/ml; injection; 1 ml which is currently out of stock and the recommended routes of administration. The National Department of Health (NDoH) has sourced stock of BetamethOther→
- Circular 30 January 2025: Revised Guidance on TB Preventative Therapy (TPT) in PregnancyThe National Guidelines on the Treatment of Tuberculosis Infection (TPT Guidelines) of 2023, include offering Isoniazid (IPT) to pregnant women (PW) who are found to be eligible for TB Preventative Therapy. This included PW living with HIV (PWLHIV) and contacts of TB cases. Click here to access the circular.Other→
- Circular 31 January 2025: Erratum to the Published Primary Healthcare (PHC) and Adult Hospital Level (AHL) Standard Treatment GuidelinesPlease note the following corrections to the Primary Healthcare Chapter 10: Infections and related conditions and the Adult Hospital Level (AHL) Chapter 9: Systemic and Healthcare-associated Infections. These amendments will be reflected in the final editions of the PHC 2024, 8 th Edition and the AHL 2024, 6 th Editions once published. Click here to access the circular.Other→
- Circular 31 March 2026: Erratum to the Adult Hospital Level STGs and EML Chapter 2 Blood and Blood Forming OrgansPlease note the following correction (in the attached document) to the Adult Hospital Level (AHL) Chapter 2: Blood and Blood Forming Organs. This amendment will be reflected in the updated edition of the AHL 2024, 6th Edition once published. For the AHL Chapter 2, the recommended methylprednisolone ester for intravenous injection in the management of Acute Immune Thrombocytopenia has been correctOther→
- Circular 31 March 2026: Interruption in the Supply of Paracetamol 500mg Tablets 20s from Innovata PharmaceuticalsInnovata Pharmaceuticals (Pty) Ltd here in after referred to as Innovata, was awarded Paracetamol; 500mg; Tablet; 20 Tablets on contracts HP09-2023SD. Innovata is currently facing supply challenges impacting the availability the item. The supplier has indicated that they will not be able supply the item until the end of the tender. Please refer to the table below for details the affected item, prOther→
- Circular 31 May 2024: Restored supply of Benzathine Benzylpenicillin injectionCircular: Restored supply of benzathine benzylpenicillin injection The Primary Health (PHC), Adult Hospital and Paediatric Hospital Level Standard Treatment Guidelines (STGs) and Essential Medicine List (EML) currently recommend benzathine benzylpenicillin injection for various indications. Historical global shortages of benzathine benzylpenicillin led to the STGs being previously amended toOther→
- Circular 6 February 2026: Availability of New Antiretroviral Products - Paediatric Abacavir/Lamivudine/Dolutegravir (60mg/30mg/5mg)The South African Government is committed to providing simplified antiretroviral treatment (ART) options to all patients, including children. This is done to ensure access to treatment for children with different needs with the aim of achieving and sustaining optimal viral suppression while avoiding complex treatment regimens, high pill burdens, and caregiver fatigue. This circular serves toOther→
- Circular 7 March 2025: Essential Drugs Programme Communication Platform on WhatsAppThe Essential Drugs Programme (EDP) communicates information around updates on medicinerelated matters, circulars on alternatives, upcoming webinars, call for stakeholder comment, generally via email and through the National Health Insurance website. The EDP has recently created a WhatsApp Communities group, called EDP Communications, on which there are 4 groups that those interested may join: STOther→
- Circular August 2024: Emicizumab clinical criteria for accessAccess to be in line with clinical criteria described below, at authorised hospital sites, prescribed by a Pharmaceutical and Therapeutics Committee (PTC) authorised prescriber (preferably by clinical haemotologist). Indication Regimen Monitoring Indication Severe haemophilia A with factor VIII inhibitors, in patients where emicizumab therapy would be cost-neutral or cost-saving compared to the uOther→
- Circular August 2024: Emicizumab for prophylaxis in the management of patients with Haemophilia A with Factor VIII inhibitorsDate: March 2023 (updated November 2023, March 2024, and August 2024) NOTE: Efficacy and safety evidence was presented to the National Essential Medicines List Committee (NEMLC) in March 2023. It was proposed by the Tertiary and Quaternary Hospital Level Expert Review Committee (and agreed to by the NEMLC) that a cost-effectiveness analysis be conducted. Scoping document for cost-effectiveness anOther→
- CirrhosisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K74.6 DESCRIPTION The end result of irreversible damage to the liver tissue, causing a widespread, diffuse process of fibrosis with regenerating nodule formation. The fibrosis and abnormal portosystemic vascular connections that result cause ongoing damage. The progression rate is variabPEML (Paeds)→
- Cleaning and disinfection of environmental surfaces in the context of COVID-19Cleaning and disinfection of environmental surfaces in the context of COVID-19Other→
- Clinical AssessmentThis booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.Other→
- Clinical DiagnosisExamination Imaging The diagnosis relies chiefly on clinical assessment and laboratory tests indicating allergic sensitisation. Clinical assessment should include a thorough history recording duration, seasonality and severity of symptoms, and examination. 7 Nasal and non-nasal symptoms can occur. 7,25,26 Symptoms of AR (which may be prolonged after allergen exposure) include the following: NasalOther→
- Clinical GuidelinesGeneral PBM measures Red cells Non-transfusion interventions to reduce RCC transfusions Platelets Plasma Cryoprecipitate Tranexamic acid Coagulation testing and monitoring Administration Ethics General PBM measures Refer to Table 1 . Red cells Refer to Table 2 . General critical care patients The need for red blood cell transfusions in the critically ill patient is a balance between the potentialOther→
- Clinical Guidelines: Patient Blood ManagementGeneral PBM statements and measures PBM measures for patients expected to bleed significantly during surgery General PBM statements and measures 1.1 All patients should have their Hb concentration measured before listing for major elective surgery. 1.2 Patients who are anaemic (Hb <13g/dL) should be investigated before elective surgery and treated appropriately, and elective non-urgent surgeryOther→
- Clinical Management of COVID-19Interim Guidance 27 May 2020Other→
- Clinical Management of Suspected or Confirmed COVID-19 Disease, Version 5This guideline outlines the clinical management of suspected or confirmed COVID-19 Disease as per the National Department of Health. Version 5. Published 24 August 2020Other→
- Clinical Monitoring of People on TreatmentEducation and counselling of eligible individuals Follow-up visits Adverse events Drug-drug interactions Treatment interruption and discontinuation Education and counselling of eligible individuals Education and counselling at treatment initiation should cover the following: what is TB exposure and infection? who is eligible for TPT? benefits of TB preventive treatment risks of TB preventive treaOther→
- Clinical PresentationsSoft tissue infection Clinical features Impetigo Discrete purulent lesions with an associated crusty exudate over the top Cellulitis Diffuse spreading pyogenic infection of the skin and superficial subcutaneous tissues Abscess Localised purulent infection, with a well demarcated purulent collection BCG adenitis Right sided axillary or supraclavicular lymphadenitis secondary to BCG immunisation atOther→
- Clinical management and considerations for treatment of influenzaClinical management and considerations for treatment of influenza Influenza is detectable in approximately 7% of children aged < 5y years hospitalised with pneumonia and 9% of individuals aged ≥5 years hospitalized with pneumonia in South Africa. [33, 34] . During the influenza season this increases to approximately 20-40% of all people hospitalised for pneumonia. For this reason, influenza muOther→
- Clinical presentation and risk factors for influenzaClinical presentation and risk factors for influenza Infection with influenza viruses can give rise to a wide range of clinical presentations, ranging from asymptomatic infection to severe illness and death depending on the characteristics of both the virus and the infected person. In the majority of people, influenza is an uncomplicated illness that is characterised by sudden onset of constOther→
- Clostridial Myonecrosis (Gas Gangrene)Clostridial Myonecrosis (Gas Gangrene)Other→
- Clostridum Difficile (Clostridioides Difficile) DiarrhoeaDescription General measures Medicine treatment Referral ICD-10 code: A04.7 *Notifiable medical condition. DESCRIPTION Diarrhoea caused by altered bowel flora due to antibiotic exposure. Clostridium difficile ( Clostridioides difficile ) infection may result in severe disease and/or the development of pseudomembranous colitis. Diagnosis is confirmed in the laboratory on a stool sample. Patients wEML (Adult)→
- Co-administration of COVID-19 and Other Vaccines - National COVID-19 Vaccination Programme Circular 3 of 2022TO: HEADS OF PROVINCIAL HEALTH DEPARTMENTS DISTRICT, HOSPITAL AND PHC MANAGERS COVID-19 VACCINE PROGRAMME MANAGERS COVID-19 VACCINATION SITE MANAGERS COVID-19 VACCINATORS NATIONAL COVID-19 VACCINATION PROGRAMME CIRCULAR 3 OF 2022 CO-ADMINISTRATION OF COVID-19 AND OTHER VACCINES COVID-19 vaccines are effective, and provide protection against COVID-19 infection. Likewise, prevention of other communOther→
- Co-treatment of HIV and Active TB in Neonates, Infants, Children, Adolescents and AdultsClick here to open the above PDF Click here for Medical Indications to Defer ART Click here for Integrated Visit Schedule for Clients on ART and Drug-Sensitive TB Treatment Click here for Drug Dosing Chart Click here for Helplines Click here for Abbreviations 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and NeonOther→
- Coagulation FactorsDescription Medicine Treatment Description Cryoprecipitate Cryoprecipitate is a source of fibrinogen, factor VIII, factor XIII, and von Willebrand factor. Active bleeding with a low fibrinogen level (<2g/L) is the main indication for cryoprecipitate in critical care and is common in obstetric haemorrhage and trauma. Cryoprecipitate administration may also be guided by viscoelastic testing in mEML (Adult)→
- Coagulation, Laboratory and MonitoringLaboratory Tests RCC testing Laboratory tests Consensus Grade 12.1 aPPT, PT and INR have little relevance in acute ongoing haemorrhage. Yes N/A Traditional tests such as aPPT, PT and INR have been standardised for the monitoring of anticoagulants and are designed to diagnose and manage factor deficiencies such as haemophilia. Standardisation within laboratories has made the results vOther→
- Colistin Dosing Guidance – AdultsDivision of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health SciencesOther→
- Collecting Blood SpecimensManagement guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.Other→
- Colposcopy & Associated Ablative ProceduresThis booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.Other→
- ComaComaOther→
- Common Cold (Viral Rhinitis)Ear, Nose and Throat ConditionsPrimary Care→
- Common Infusions in PaediatricsCommon infusions in paediatricsOther→