ENT Conditions Guidelines 2018 Update
Explore the latest updates in ENT conditions guidelines for primary healthcare, including changes in medication for allergic rhinitis, acute otitis media, and tonsillitis/pharyngitis. Access detailed evidence and recommendations from the National Essential Medicines List Committee.
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Chapter 19 ENT 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
Allergic Rhinitis DESCRIPTION Inflammation of the mucous membranes of the nose and paranasal sinuses in response to an allergen e.g. pollen, house dust, grasses, and animal hair. CHANGES Fluticasone ADDED and Beclomethasone REMOVED Fluticasone contra-indicated in patients on PIs these patients should be referred for beclomethasone. REASON Fluticasone is as effective as and cheaper than beclomethasone Protease inhibitors increase blood concentrations of budesonide & fluticasone - could lead to Cushing s syndrome 3
Otitis media, acute DESCRIPTION Inflammation of the external ear with infection of the ear canal, often due to Gram negative bacilli (especially P. aeruginosa). Pain is increased when chewing and the lining of the canal may be either inflamed or swollen with dry or moist debris or even a white or clear discharge. CHANGES Amoxicillin, oral: option ADDED to continue antibiotics for a further 5 days, if pain or discharge persists. Amoxicillin/clavulanic acid, oral: ADDED for patients administered amoxicillin within previous 30 days or poor response to 10-day course of amoxicillin. REASON Aligned with Paediatric Hospital Level STGs and EML, 2017. 4
Tonsillitis and pharyngitis DESCRIPTION A painful red throat and/or enlarged inflamed tonsils. White pus exudates, either spots. or patches, may be present. Tender anterior cervical lymphadenopathy may be present. CHANGES Children and adults Amoxicillin, oral: ADDED REASON There are continuous supply challenges with phenoxymethylpenicillin & thus amoxicillin recommended as an alternative option. 5
