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Clinical Guidelines Clinical guidelines Exported on 11/23/2019 Clinical guidelines Clinical guidelines - Diagnosis and treatment manual For curative programmes in hospitals and dispensaries Guidance for prescribing © Médecins Sans Frontières, 2019 All rights reserved for all countries. No reproduction, translation and adaptation may be done without the prior permission of the Copyright owner. Médecins Sans Frontières. Clinical guidelines - Diagnosis and treatment manual. 2019 edition. ISBN 978-2-37585-041-1 Clinical guidelines - Diagnosis and treatment manual – 2 Clinical guidelines Table of contents • Authors/Contributors(see page 6) • Preface(see page 7) • Abbreviations and acronyms(see page 8) • Chapter 1: A few symptoms and syndromes(see page 10) • Shock(see page 11) • Seizures(see page 17) • Hypoglycaemia(see page 21) • Fever(see page 23) • Pain(see page 26) • Anaemia(see page 33) • Severe acute malnutrition(see page 38) • Chapter 2: Respiratory diseases(see page 43) • Acute upper airway obstruction(see page 44) • Rhinitis and rhinopharyngitis (common cold)(see page 47) • Acute sinusitis(see page 48) • Acute pharyngitis(see page 50) • Diphtheria(see page 53) • Other upper respiratory tract infections(see page 56) • Otitis(see page 60) • Whooping cough (pertussis)(see page 63) • Bronchitis(see page 65) • Bronchiolitis(see page 67) • Acute pneumonia(see page 69) • Staphylococcal pneumonia(see page 75) • Asthma(see page 77) • Pulmonary tuberculosis(see page 82) • Chapter 3: Gastrointestinal disorders(see page 84) • Acute diarrhoea(see page 85) • Shigellosis(see page 88) • Amoebiasis(see page 90) • Disorders of the stomach and duodenum(see page 92) • Stomatitis(see page 95) • Chapter 4: Skin diseases(see page 98) • Dermatology(see page 99) • Scabies(see page 100) • Lice (pediculosis)(see page 103) • Superficial fungal infections(see page 105) • Bacterial skin infections(see page 108) • Cutaneous anthrax(see page 113) • Endemic treponematoses(see page 115) • Leprosy(see page 118) • Herpes simplex and herpes zoster(see page 121) • Other skin disorders(see page 123) • Chapter 5: Eye diseases(see page 126) • Xerophthalmia (vitamin A deficiency)(see page 127) • Conjunctivitis(see page 129) • Trachoma(see page 131) • Periorbital and orbital cellulitis(see page 133) • Other pathologies(see page 135) Table of contents – 3 Clinical guidelines • Chapter 6: Parasitic diseases(see page 137) • Malaria(see page 138) • Human african trypanosomiasis (sleeping sickness)(see page 146) • Leishmaniases(see page 149) • Intestinal protozoan infections (parasitic diarrhoea)(see page 152) • Flukes(see page 154) • Schistosomiases(see page 156) • Cestodes(see page 159) • Nematode infections(see page 161) • Filariasis(see page 165) • Chapter 7: Bacterial diseases(see page 171) • Bacterial meningitis(see page 172) • Tetanus(see page 178) • Enteric (typhoid and paratyphoid) fevers(see page 184) • Brucellosis(see page 188) • Plague(see page 190) • Leptospirosis(see page 193) • Relapsing fever (borreliosis)(see page 196) • Eruptive rickettsioses(see page 199) • Chapter 8: Viral diseases(see page 202) • Measles(see page 203) • Poliomyelitis(see page 206) • Rabies(see page 208) • Viral hepatitis(see page 213) • Dengue(see page 217) • Viral haemorrhagic fevers(see page 224) • HIV infection and AIDS(see page 228) • Chapter 9: Genito-urinary diseases(see page 242) • Nephrotic syndrome in children(see page 243) • Urolithiasis(see page 246) • Acute cystitis(see page 247) • Acute pyelonephritis(see page 249) • Acute prostatitis(see page 252) • Genital infections(see page 253) • Urethral discharge(see page 255) • Abnormal vaginal discharge(see page 257) • Genital ulcers(see page 260) • Lower abdominal pain in women(see page 263) • Upper genital tract infections (UGTI)(see page 264) • Venereal warts(see page 267) • Major genital infections (summary)(see page 269) • Metrorrhagia (unrelated to pregnancy)(see page 273) • Chapter 10: Medical and minor surgical procedures(see page 274) • Dressings(see page 275) • Treatment of a simple wound(see page 278) • Burns(see page 288) • Abscess(see page 296) • Pyomyositis(see page 299) • Leg ulcers(see page 301) • Necrotising infections of the skin and soft tissues(see page 303) • Venomous bites and stings(see page 305) • Dental infections(see page 309) • Chapter 11: Mental disorders in adults(see page 311) Table of contents – 4 Clinical guidelines • Anxiety(see page 312) • Insomnia(see page 313) • Agitation(see page 314) • Mental confusion(see page 315) • Post-traumatic stress disorder(see page 316) • Depression(see page 318) • Psychotic disorders(see page 320) • Chapter 12: Other conditions(see page 324) • Sickle cell disease(see page 325) • Diabetes type 2 in adults(see page 332) • Essential hypertension in adults(see page 336) • Heart failure in adults(see page 340) • Endemic goitre and iodine deficiency(see page 345) • Appendices(see page 347) • Appendix 1a. Normal daily maintenance IV fluids in children 1 month(see page 348) • Appendix 1b. 1.5 x daily maintenance IV fluids in children 1 month(see page 350) • Appendix 2. Assessment and treatment of diarrhoea(see page 352) • Main references(see page 355) • In the same collection(see page 356) Table of contents – 5 Clinical guidelines Authors/Contributors This guide has been developed by Médecins Sans Frontières with valuable contributions from: Suna Balkan, Pierre Barel, Marie-Claude Bottineau, Philippa Boulle, Cristina Carreno, Marta Cereceda, Eric Comte, Anne-Sophie Coutin, Cédric Dassas, Martin De Smet, Frédérique Drogoul, Tanja Ducomble, Mohamed Elsonbaty Ramadan, Monique Gueguen, Véronique Grouzard, Victor Illanes, Vincent Ioos, Kiran Jobanputra, Rupa Kanapathipillai, Evelyne Laissu, Marc Legrelle, Caroline López Vázquez, Sophie Pilon, Amulya Reddy, Jean Rigal, Catrin Schulte-Hillen, Marianne Sutton, Elisabeth Szumilin, Clara Van Gulik Published by Médecins Sans Frontières Authors/Contributors – 6 Clinical guidelines Preface This guide is designed for use by medical professionals involved in curative care at the dispensary and primary hospital. We have tried to respond in the simplest and most practical way possible to the questions and problems faced by field medical staff, using the accumulated field experience of Médecins Sans Frontières, the recommendations of reference organizations such as the World Health Organization (WHO) and specialized works in each field. This edition touches on the curative and, to a lesser extent, the preventive aspects of the main diseases encountered in the field. The list is incomplete, but covers the essential needs. This guide is used not only in programmes supported by Médecins Sans Frontières, but also in other programmes and in other contexts. It is notably an integral part of the WHO Emergency Health Kit. Médecins Sans Frontières has also issued French and Spanish editions. Editions in other languages have also been produced in the field. This guide is a collaborative effort of medical professionals from many disciplines, all with field experience. Despite all efforts, it is possible that certain errors may have been overlooked in this guide. Please inform the authors of any errors detected. It is important to remember, that if in doubt, it is the responsibility of the prescribing medical professional to ensure that the doses indicated in this manual conform to the manufacturer ’s specifications. To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions. As treatment protocols are regularly revised, please check the monthly updates. Preface – 7 Clinical guidelines Abbreviations and acronyms ACE angiotensin converting enzyme ACT artemisinin-based combination therapy AFB acid-fast bacillus ARV antiretroviral BCG bacillus Calmette-Guérin BMI body mass index BP blood pressure °C degree Celsius co-amoxiclav amoxicillin + clavulanic acid co-trimoxazole sulfamethoxazole + trimethoprim CRT capillary refill time CSF cerebrospinal fluid CMV cytomegalovirus D1 (D2, D3, etc.) Day 1 or first day (Day 2 or 2nd day, Day 3 or 3rd day, etc.) dl decilitre g gram HBP high blood pressure (hypertension) HF heart failure HIV human immunodeficiency virus HR heart rate IM intramuscular IO intraosseous IU international unit IV intravenous kcal kilocalorie kg kilogram LP lumbar puncture M million Abbreviations and acronyms – 8 Clinical guidelines mg milligram ml millilitre mmHg millimetre of mercury mmol millimole MSF Médecins Sans Frontières NSAID nonsteroidal anti-inflammatory drug ORS oral rehydration solution or salts PCP pneumocystosis PO per os – oral administration RR respiratory rate SAM severe acute malnutrition SC subcutaneous SMX sulfamethoxazole SMX + TMP sulfamethoxazole + trimethoprim = co-trimoxazole SpO2 arterial blood oxygen saturation measured by pulse oximetry tab tablet TB tuberculosis TMP trimethoprim TT tetanus toxoid WHO World Health Organization Abbreviations and acronyms – 9 Clinical guidelines Chapter 1: A few symptoms and syndromes • Shock(see page 11) • Seizures(see page 17) • Hypoglycaemia(see page 21) • Fever(see page 23) • Pain(see page 26) • Anaemia(see page 33) • Severe acute malnutrition(see page 38) Chapter 1: A few symptoms and syndromes – 10 Clinical guidelines Shock Acute circulatory failure leading to inadequate tissue perfusion which, if prolonged, results in irreversible organ failure. Mortality is high without early diagnosis and treatment. • Aetiology and pathophysiology(see page 11) • Hypovolaemic shock(see page 11) • Septic shock(see page 11) • Cardiogenic
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