TREATMENT OF AIDS RELATED AND OPPORTUNISTIC INFECTIONS 1
CHEST INFECTIONS (suspect if cough, fever, chest pain, short of breath) Bacterial pneumonia and or bronchitis Amoxicillin 500 tds 7 days or other Pneumocystis Carini (=Avium): PCP If severe: Cotrimoxazole 960 mg qds 2-3- weeks; or refer to admit TB Refer to regular TB programme ORAL / OESOPHAGUS Oral thrush Gentian Violet tds for 7days Nystatin oral suspension 2mls qds Nystatin lozenges suck qds 1 week Amphotericin B lozenges 1 tab suck tds Daktarin gel b.d. for 14 days Oesophagus Candidiasis (pain Fluconazole 100 mg daily for 2 –4 weeks OR swallow, unable to eat, burning chest, Ketoconazole 400 mg daily for 2 –4 weeks thrush at back palatum pharynx Nystatin oral suspension or lozenges: suck and swallow qds entrance) Oral hairy leukoplakia Brush tongue, no other treatment possible (White vertical stripes on the side of the tongue, caused by EB virus Gingivitis Refer to dentist / dental hygienist Painful, bleeding gums Oral Chlorhexidine mouth wash Recurrent aphthous ulcers Chlorhexidine mouth wash Analgesia e.g. Paracetamol If recurrent and severe needs referral to dentist for oral steroid rinses SKIN Herpes Simplex Chlorhexidine or gentian violet; zinc oxide cream; if severe: Aciclovir 400 mg tds for 7 days (or Valaciclovir 500 mg bd for 7 days) Herpes Zoster Chlorhexidine or Gentian violet; zinc oxide cream; if severe: Aciclovir 800 mg 5 x/day for 7 days (Valaciclovir 1000 mg tds for 7 days) Pain: Paracetamol/ Brufen ; Amitriptyline 25-75mg nocte and / or Carbamazepine 200mg tds (Start with 100mg tds for 5/7) Molluscum Contagiosum (glossy Treatment not necessary; or else: prick them or gently nitroglycerin papules) (children: Ascabiol tds to lesions only) Scabies (might be extensive): look at Treat: Ascabiol finger webs. Itchy eruptions (Hyper-pigmented Aqueous cream, antihistamines spots with pale centres) Dry itchy skin (pruritis); urticaria Bath oils, no soap, plenty regularly apply aqueous cream Antihistamine (Allergex); Phenerghan 25mg nocte; Calamine Pimpels like acne: folliculitis Antiseptic local, 2% sulfur cream bd, other acne treatment, oral (very common) Tetracycline/Doxycycline course Bacterial infections: pus (impetigo, Cloxacillin, Erythromycin, and other furunculosis) Seborrhoic dermatitis eczema (very Topical corticosteroids: 1% Hydrocortisone cream or stronger; Selsun common) shampoo; 2% sulfur cream at night; if severe: systemic anti-fungus tablets, such as Fluconazole Psoriasis (common) Topical steroids as with seborrhoic dermatitis; if severe: skin specialist (systemic corticosteroids) Fungal infections (candida, ringworm, Whitfield’s ointment, 2% Sulfur, Canestan, Daktarin, and other. tinea: foot, groins, axilla, etc) If recurrent or severe: oral treatment: Griseofulvin 500 mg 3 months Ketoconazole 200 mg daily for 2-3 weeks Kaposi sarcoma (malignant tumor) Refer, Need ARV (WHO stage 4)
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Primary HIV/AIDS Care, Dr. Clive Evian. 4th edition, sept 2003. Handbook of HIV medicine, Douglas Wilson a.o.Oxford University Press, Southern Africa 2002. Clinical guidelines for managing HIV/AIDS in Primary care; Gauteng Health Department, 2001
KHUTŠO-KURHULA, clinic-based Wellness programme, Co-operative project Greater Tzaneen subdistrict, version: Nov 2004
GASTRO-INTESTINAL Diarrhea, always to take very serious, especially children.
Rehydration; diet advises for patients with diarrhea: Drink lots of fluid, >8 cups a day of water, soups, fruit juice, oral rehydration solution - ORS Replace salt and minerals –eat vegetables & fruits Drink liquid in between meals Avoid food with lots of fat like butter, cream, margarine Decrease milk and dairy product intake – rather use yoghurt or maas Eat starchy foods – white rice, pasta, bananas, cooked porridge or pap Eat small, frequent meals rather than big ones. Avoid foods that have a laxative effect –prunes Avoid – coffee, tea, alcohol, gas cool drinks If no blood in stools: Cotrimoxazole 960 bd + Metronidazole 400 mg tds for 7 days: continue for 2 weeks if improving; If no improvement: try Albendazole or Mebendezole; If blood: try Amoxil 500mg tds for 7 days or Erythromycin 500 mg 6 hourly for 5 days If Chronic: Loperamide 4 mg stat and after each stool up to max 16 mg/24 hours; Codeine 10-60 mg 4 hourly Refer if no improvement after 5 days or patient becomes weaker GENITAL: STI are more severe in HIV/AIDS patients; treat seriously and include the sexual partners; screen for syphilis (RPR); promote condom use. Discharge / burning micturition, Follow protocols for syndromic management of STI Can be: - Chlamydia, - Gonorrhoea or - Trichomonas Ulcers/ sores/ blisters, Can be: Follow protocols for syndromic management of STI - Genital herpes, - Syphilis or - Chancroid Genital herpes can be very severe, big Treat with Acyclovir 400 mg tds for 7 days persistent ulcers and very painful (>1 Treat the pain month = WHO stage 4) Refer for ARV Vaginal discharge and itchy red rash: Daktarin or Nystatine cream; Canestan (Clotrimazole) vaginal pessaries Candida Vaginitis If severe persistent give oral treatment: Red itchy rash on glans penis: Ketoconazole 400 mg daily for 1-2 week Candida Balanitis Fluconazole 100 mg daily for 2 weeks Genital warts (Condylomata Accuminata) Pubic Lice and Scabies PALLIATIVE CARE Pain, general (think of chidren!) Podophyllin 20% solution: paint and wash off after 6 hours repeat 12 hourly for 3 days. PROTECT UNAFFECTED PARTS with zinc-oxide cream Gamma Benzene-hexachloride lotion or Benzyl Benzoate emulsion rub and leave for 24 hours Give pain tablets on fixed times (clock), and follow ‘pain ladder’: 1. Start with Paracetamol (increase to 500 mg 4 hourly) 2. Paracetamol + Codeine (codeine up to 30 mg 4 hourly) or/and NSAID (Brufen 400 mg 6-hourly) 3. Refer for Morphine slow release if no success Amitryptiline 25-75mg nocte and / or Carbamazepine 200mg tds (start with 100mg tds for 5/7) Crush 4 Metronidazole tablets and mix with 2 liter saline solution: wash wounds
Pain neuropathic (herpes ulcers, legs or hands burning sensations) Malodorous wounds: bedsores, ulcers, etc
NB: Carbamazepine interacts with a number of ARV’s leading to decreased effectivity
KHUTŠO-KURHULA, clinic-based Wellness programme, Co-operative project Greater Tzaneen subdistrict, version: Nov 2004