Malawi Standard Treatment Guidelines & Essential Medicines List 2015
Malawi Standard Treatment Guidelines & Essential Medicines List 2015
Ministry of Health
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Table of Contents
Foreword..............................................................................iii
References............................................................................v
Acknowledgements..............................................................vii
Prescribing Guidelines..........................................................xi
1.0 Blood and Haematological Condions........................1
2.0 Cardiovascular diseases............................................47
3.0 Central nervous system.............................................62
4.0 Ear nose and throat condions................................95
5.0 Emergencies...........................................................106
6.0 Endocrine disorders................................................121
7.0 Gastrointesnal condions...................................134
8.0 Hepac disorders....................................................161
9.0 Infecous diseases..................................................162
10.0 Oncology.................................................................225
11.0 Musculoskeletal disorders......................................246
12.0 Sexual and Reproducve Health ..............................257
13.0 Ophthalmic condions........................................304
14.0 Oral maxillofacial condions...................................320
15.0 Parasic diseases.....................................................333
16.0 Respiratory condions............................................371
17.0 Sexually transmied infecons................................393
18.0 Skin condions........................................................417
19.0 Vaccinaons............................................................437
MSTG 2015
i
20.0 Bites, burns and wounds.........................................439
21.0 Renal condions ....................................................454
22.0. Poisoning................................................................465
23.0 Nutrional Disorders.................................................475
24.0 Pain management and Palliave care....................504
25.0 Psychiatric condion..............................................520
MSTG 2015
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Foreword
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List of Core Contributors to the 5th Edion of
MSTG/MEML
NAME INSTITUTION
Dr Charles Mwansambo Ministry of Health
Dr George ChithopeMwale Ministry of Health
Dr. A. Chitsa Banda Malawi Defence Force
Dr. Henry Ndindi Ministry of Health
Albert Khuwi Ministry of Health
Enock Phale Ministry of Health
Tadala Hamisi Kamuzu Central Hospital
Ephraim Chale Kamuzu Central Hospital
Chikondi Kadawa Ministry of Health
Dr Mebratu Bejiga Clinton Health Access
Iniave
Christopher Connolly Clinton Health Access
Iniave
Alfred Kasito Clinton Health Access
Iniave
Michael Udedi Ministry of Health
Dr Amos Nyaka Kamuzu Central Hospital
Dr Rachel MlothaMitole Kamuzu Central Hospital
Dr Peter Kazembe Baylor Trust
Dr Bridon M’baya Malawi Blood
Transfusion Services
Dr Charles Dzamala College of medicine
Dr Dan Namarika Partners in Hope Clinic
Dr Rodney Kalanda The MEDI Clinic
Dr Tiffany Priester Seventh Day Advenst
Hospital
Dr Y. B Mlombe College of Medicine
Dr Moses Chisale Central Medical Stores
Trust
Chitsanzo Mafuta Zomba Mental Hospital
Dr Jen Ahrens College of Medicine
MSTG 2015
viii
NAME INSTITUTION
Levie Mwale Queen Elizabeth
Central Hospital
Dr Kondwani Chalulu Queen Elizabeth Central
Hospital
Dr Samson Mndolo Queen Elizabeth Central
Hospital
Dr Leo Masamba Queen Elizabeth
Central Hospital
Dr Jessie Mlotha Namarika Kamuzu Central Hospital
Dr Peter Jeke Mzuzu Central Hospital
Dr John Chipolombwe Mzuzu Central Hospital
Dr Carlos Valera Kamuzu Central Hospital
Catherine Chiwaula Ministry of Health
Emmaculate Kambiya Ministry of Health
Lumbani Makwakwa Chrisan Health
Associaon of Malawi
Dr Martha Makwero Queen Elizabeth Central
Hospital
Dr Kabeya Maguy Zomba Central Hospital
Janet Guta Ministry of Health
Syliver Kathumba Ministry of Health
Godfrey Kadewere Pharmacy, Medicines
and Poisons Board
Kent Kawonga Queen Elizabeth Central
Hospital
Gelson Kuweruza Queen Elizabeth Central
Hospital
Samuel Nowa Kasungu District Health
Office
Dr Jarome Nkhambule Kasungu District Health
Office
R. J Mwale College of Medicine
Angellina Chilumpha Zomba Mental Hospital
MSTG 2015
ix
NAME INSTITUTION
Dr Gian Samonte Kamuzu Central Hospital
Mercy T.Z. Magombo Zomba Central Hospital
Emma Mchikaya Zomba Central Hospital
Laston Chiko Ministry of Health
Lameck Thambo Palliave Associaon of
Malawi
Dr. Leonard Banza Kamuzu Central Hospital
Doreen Alli Ministry of Health
Dr Stone Kabuluzi Ministry of Health
Sheila Bandazi Ministry of Health
Dr Owen Malemia Blantyre District Health
Office
Dr Lillian Chunda Kamuzu Central Hospital
MSTG 2015
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Prescribing guidelines
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45
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46
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52
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53
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54
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55
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56
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59
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61
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71
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509
24. Pain Management and Palliative Care
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MSTG 2015
510
24. Pain Management and Palliative Care
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511
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"
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MSTG 2015
513
24. Pain Management and Palliative Care
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MSTG 2015
514
515
MSTG 2015
24. Pain Management and Palliative Care
516
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MSTG 2015
24. Pain Management and Palliative Care
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!"
# ( *
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MSTG 2015
518
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• - • *#)
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520
25. Psychatric Conditions
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521
25. Psychatric Conditions
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MSTG 2015
522
25. Psychatric Conditions
9
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MSTG 2015
523
25. Psychatric Conditions
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MSTG 2015
524
25. Psychatric Conditions
)
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MSTG 2015
525
25. Psychatric Conditions
1$
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MSTG 2015
526
25. Psychatric Conditions
g p
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+6. % H
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MSTG 2015
527
25. Psychatric Conditions
1 $
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MSTG 2015
528
25. Psychatric Conditions
• 0
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MSTG 2015
529
25. Psychatric Conditions
!
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MSTG 2015
530
25. Psychatric Conditions
$ %
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MSTG 2015
531
25. Psychatric Conditions
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MSTG 2015
532
25. Psychatric Conditions
•
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MSTG 2015
533
25. Psychatric Conditions
$
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MSTG 2015
534
25. Psychatric Conditions
1$
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MSTG 2015
535
25. Psychatric Conditions
• !
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MSTG 2015
536
25. Psychatric Conditions
. !3+
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MSTG 2015
537
25. Psychatric Conditions
• !
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MSTG 2015
538
25. Psychatric Conditions
MSTG 2015
539
25. Psychatric Conditions
( (
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MSTG 2015
540
25. Psychatric Conditions
•
)
!
++ !
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MSTG 2015
541
25. Psychatric Conditions
g p
+6(+& / 0 #% '
-
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MSTG 2015
542
25. Psychatric Conditions
( (
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MSTG 2015
543
25. Psychatric Conditions
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MSTG 2015
544
25. Psychatric Conditionss
MSTG 2015
545
25. Psychatric Conditions
1
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MSTG 2015
546
25. Psychatric Conditions
!
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MSTG 2015
547
25. Psychatric Conditions
•
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MSTG 2015
548
25. Psychatric Conditions
• +
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MSTG 2015
549
25. Psychatric Conditions
$ $
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MSTG 2015
550
25. Psychatric Conditions
;
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MSTG 2015
551
25. Psychatric Conditions
.
MSTG 2015
552
25. Psychatric Conditions
( (
MSTG 2015
553
25. Psychatric Conditions
$"
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MSTG 2015
554
25. Psychatric Conditions
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MSTG 2015
555
25. Psychatric Conditions
$ $
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MSTG 2015
556
25. Psychatric Conditions
$%
MSTG 2015
557
25. Psychatric Conditions
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MSTG 2015
558
25. Psychatric Conditions
• =
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MSTG 2015
559
25. Psychatric Conditions
)
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MSTG 2015
560
25. Psychatric Conditions
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MSTG 2015
561
25. Psychatric Conditions
• & !
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MSTG 2015
562
25. Psychatric Conditions
•
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MSTG 2015
564
25. Psychatric Conditions
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MSTG 2015
565
25. Psychatric Conditions
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MSTG 2015
566
25. Psychiatric Conditions
$
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MSTG 2015
567
25. Psychiatric Conditions
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MSTG 2015
568
25. Psychiatric Conditions
• # ! !
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MSTG 2015
569
25. Psychiatric Conditions
( (
MSTG 2015
570
25. Psychiatric Conditions
MSTG 2015
571
25. Psychiatric Conditions
# . ! / $" !
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MSTG 2015
572
25. Psychiatric Conditions
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MSTG 2015
573
25. Psychiatric Conditions
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MSTG 2015
574
Index
.
21
9 $ 34
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MSTG 2015
575
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MSTG 2015
576
7 4 %+ + .
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MSTG 2015
577
/ !. 7' !
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MSTG 2015
578
+ #4 1 +"
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MSTG 2015
579
' / !# = ; +
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MSTG 2015
580
...
ϱ
..
MEML 2015
i
..
Contents
Introducon................................................................................................................i
Presentaon of Informaon........................................................................................v
1. General.....................................................................................................................v
2. Categorisaon/Priorisaon of drug items.................................................................vi
3. Emergency orders........................................................................................................ix
4. Lisng by category/priority within secons.................................................................ix
5. Abbreviaons....................................................................................................x
1. Anaesthecs.................................................................................1
1.1 General anaesthecs and oxygen..........................................................................1
1.1.1 Inhalaon Medicines.................................................................................................1
1.1.2. Injectable Medicines................................................................................................1
1.2 Local anaesthecs..................................................................................................1
1.3 Preoperave medicaon and sedaon for shortterm procedures............................2
2. Medicines for Pain and Palliave Care..............................................................3
2.1 Nonopioids and nonsteroidal aninflammatory medicines (NSAIMs).....................3
2.2 Opioid analgesics...................................................................................................3
2.3 Medicines for other common symptoms for palliave care................................3
3. Anallergics and medicines used in Anaphylaxis.....................................................4
3.1 Anhistamines..........................................................................................4
3.2 Medicines used in nasal allergy....................................................................................4
4. Andotes and other medicines used in poisonings..................................................6
5. Anconvulsants/Anepilecs.....................................................................7
6. Aninfecve medicines.........................................................................................8
6.1 Anhelmincs...................................................................................................8
6.1.1Intesnal anthelmincs............................................................................................8
6.1.2. Anfilarials..........................................................................................................8
6.1.3Anschistosomals and other antrematode medicines............................................8
6.2 Anbacterials............................................................................................................8
6.2.1.Penicillins and cephalosporins (Beta Lactam medicines)....................................8
6.2.2Other anbacterials..................................................................................................9
6.2.3Anleprosy medicines............................................................................................10
6.2.3Anleprosy medicines...........................................................................................10
6.3 Anfungal medicines...............................................................................................10
6.4 Anviral medicines................................................................................................11
6.4.1Anherpes medicines............................................................................................11
6.4.2Anretrovirals......................................................................................................11
6.5 Anprotozoal medicines..............................................................................................13
6.5.1Anamoebics and angiardiasis medicines..............................................................13
6.5.2Anleishmaniasis medicines.................................................................................13
6.5.3Anmalarials..............................................................................................13
6.5.4Anpneumocytosis and Antoxoplasmosis medicines..............................................14
6.5.5Antrypanosomal medicines (African)...............................................................14
7. Anmigraine medicines......................................................................................15
7.1 For treatment of acute aack.............................................................................15
7.2 For prophylaxis.......................................................................................................15
8. Anneoplasc and immunosuppressant medicines........................................16
8.1 Immunosuppressive medicines...........................................................................16
8.2 Cytotoxic and adjuvant medicines......................................................................16
8.3 Hormones and anhormones.............................................................................16
9 Anparkinsonism medicines................................................................................17
10 Medicines affecng the blood..............................................................................18
10.1 Ananaemic medicine........................................................................................18
10.2 Medicines affecng coagulaon..........................................................................18
10.3 Medicines to treat hyperkalaemia.........................................................................18
MEML 2015
ii
11. Blood products and plasma substutes.................................................................19
12 Cardiovascular medicines......................................................................................20
12.1 Ananginal medicines................................................................................................20
12.2 Anarrhythmic medicines.........................................................................................20
12.3 Anhypertensive medicines.......................................................................................20
12.4 Medicines use in heart failure....................................................................................20
12.5 Anthromboc medicines....................................................................................21
12.6 Lipidlowering agents.............................................................................................21
12.7 Anhypotensive medicines...................................................................................21
13 Dermatological medicines (Topical).......................................................................22
13.1 Anfungal medicines............................................................................................22
13.2 Aninfecve medicines......................................................................................22
13.3 Aninflammatories and anpruric medicines.....................................................23
13.4 Medicines affecng skin differenaon and proliferaon..........................................23
13.5 Scabicides and pediculocides................................................................................24
13.6 Other topical preparaons..................................................................................24
14. Diagnosc agents..................................................................................................25
14.1 Ophthalmic medicines...........................................................................................25
14.2 Radiocontrast media.............................................................................................25
15 Disinfectants and Ansepcs.................................................................................27
15.1 Ansepcs...................................................................................................27
15.2 Disinfectants............................................................................................................27
16. Diurecs.........................................................................................................28
17. Gastrointesnal medicines....................................................................................29
17.1 Antacids and other anulcers medicines.....................................................................29
17.2 Anemecs........................................................................................................29
17.3 Aninflammatory medicines.....................................................................................29
17.4 Laxavesand Catharcs.........................................................................................29
17.5 Medicines used in diarrhoea.................................................................................30
17.5.1 Oral rehydraon preparaons .........................................................................30
17.5.2 Medicines for diarrhoea in children.................................................................30
17.5.3 Anmolity medicines...................................................................................30
17.6 Anhaemorrhoidals..........................................................................................30
17.7 Anspasmodics .........................................................................................................30
18. Hormones, other endocrine medicines and Contracepves...................................31
18.1 Adrenal hormones and synthec substutes..............................................................31
18.2 Androgens...............................................................................................31
18.3 Contracepves...........................................................................................................31
18.3.1. Oral Hormonal contracepves ........................................................................31
18.3.2 Injectable Hormonal contracepves............................................................31
18.3.3 Intrauterine devices (IUD)...............................................................................31
18.3.4 Barrier contracepves.......................................................................................32
18.3.5 Implantable Contracepves...............................................................................32
18.4 Oestrogens..................................................................................................32
18.5 Insulins and other medicines used for diabetes.........................................................32
18.6 Ovulaon inducers...............................................................................................32
18.7 Progestogens.............................................................................................32
18.8 Thyroid hormones and anthyroid medicines...........................................................33
MEML 2015
iii
19. Immunologicals........................................................................................34
19.1 Immunological diagnosc agents ....................................................................34
19.2 Sera and immunoglobulins..........................................................................34
19.3 Vaccines.............................................................................................34
19.3.1 Vaccines for universal immunisaon....................................................34
19.3.2 Vaccines for specific individuals..........................................................35
20 Muscle relaxants (peripherally acng) and cholinesterase inhibitors...........36
21. Ophthalmological preparaons..................................................................37
21.1.Aninfecve agents.................................................................................37
21.2 Aninflammatory agents............................................................................37
21.3 Local anaesthecs.......................................................................................38
21.4 Miocs and anglaucoma medicines..............................................................38
21.5 Mydriacs...................................................................................38
21.6 Others........................................................................................38
22 Obstetric medicines.....................................................................................39
22.1 Oxytocics...................................................................................39
22.2 Anoxytocics..................................................................................39
22.3 Myometrial relaxants.................................................................................39
22.4 Medicines used in severe PIH and eclampsia................................................39
22.5 Medicines used in primary PPH..................................................................39
22.5 Medicines used in secondary PPH..................................................................39
23 Peritoneal dialysis soluons.........................................................................40
24 Medicines for mental and behavioural disorders........................................41
24.1 Medicines used in psychoc disorders...................................................41
24.2 Medicines used in mood disorders.............................................................41
24.2.1 Medicines used in depressive disorders..............................................41
24.2.2 Medicines used in bipolar disorders.....................................................41
24.3 Medicines for enxiety disorders................................................................42
24.4 Medicines used for obsessivecompulsive disorders...................................42
24.5 Medicines for disorders due to psychoacve substance use......................42
24.6 Other Medicines for mental disorder.......................................................42
25. Medicines acng on the Respiratory Tract.........................................43
25.1 Anasthmac and medicines for chronic obstrucve
pulmonary disease ..................................................................................................43
26. Soluons correcng water, electrolytes and acidbased disturbances..........44
26.1 Oral preparaons........................................................................................44
26.2 Parenteral preparaons.............................................................................44
27 Vitamins and minerals...............................................................................45
28. Ear, Nose and throat medicines in Children...............................................46
28.1 Preparaons for the ear.............................................................................46
28.2 Preparaons for the oropharynx...............................................................46
29. Specific Medicines for Neonatal Care..........................................................47
29.1 Medicines administered to the neonate............................................................47
29.2 Medicines administered to the mother.....................................................47
30. Medicines for Arthris............................................................................48
30.1 Medicines used to treat gout............................................................................48
31.1 Medicines used to treat Nutrional Disorders..............................................48
MEML Index ..........................................................................................................50
MEML 2015
iv
MEML 2015
v
( .# 7 ' " # # !
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vi
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vii
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viii
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7
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22
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23
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28
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32
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33
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40
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52
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53
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55
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56
5 %
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57
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MEML 2015
58