Page 0 of 401 Tuvalu Standard Treatment Guidelines 2010 TUVALU STANDARD TREATMENT GUIDELINES 1 ST EDITION

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1 Page 0 of 401 Tuvalu Standard Treatment Guidelines 2010 TUVALU STANDARD TREATMENT GUIDELINES 1 ST EDITION MINISTRY OF HEALTH, TUVALU

2 Page 1 of 401 Tuvalu Standard Treatment Guidelines 2010 TABLE OF CONTENTS List of tables, boxes and figures..2 Foreword..3 Abbreviations and acronyms... 4 Acknowledgements.5 Introduction..6 Chapters Managing diabetes mellitus.7 Cardiovascular...34 Respiratory tract.90 Antibiotics Gynaecology and obstetrics.194 Dental treatments.206 Paediatrics 215 Essential Medicines List revised Essential Medicines List for Children Sources Recommendation for HIV Medicine & Sexual Health Care in Pacific Small Island Countries & Territories Index

3 Page 227 of 401 Tuvalu Standard Treatment Guidelines 2010 ESSENTIAL MEDICINES LIST REVISED TUVALU ESSENTIAL DRUG LIST WHO Drug name, strength and dosage form Outer Restrict use Cost $A COMMENTS Island 1 ANAESTHETICS 1.1 GENERAL ANAESTHETICS Halothane inhalation 39 Isoflurane inhalation 56 Ketamine 50mg/ml injection 2.1 Nitrous oxide gas inhalation Oxygen gas inhalation 98(G) Soda lime powder 5.63 Thiopentone 0.5% injection LOCAL ANAESTHETICS Bupivacaine 0.5% plain injection 1 Bupivacaine 0.5% heavy (spinal) injection 1.3 Need more G size 227

4 Page 228 of 401 Tuvalu Standard Treatment Guidelines 2010 Lignocaine 2%plain injection Yes 1 Lignocaine 2% + adrenaline 1:80,000 dental cart Yes 0.4 Lignocaine 10% pump spray Anaesthetist Ethylchloride spray dentist PRE-OPERATIVE MEDICATION Atropine 600mcg/ml injection 0.1 Diazepam 10mg/2ml injection 0.15 Droperidol 10mg/2.5ml injection Anaesthetist 3.38 Diazepam 5mg tablet 0.01 Fentanyl 100mcg/2ml injection 0.73 Midazolam 15mg/3ml injection Anaesthetist 2.4 Morphine 10mg/ml injection 0.34 Pethidine 50mg/ml injection O&G only 0.3 Promethazine 50mg/2ml injection 0.26 alt spray to lignocaine 2 ANALGESICS, ANTIPYRETICS, NSAID's, DRUGS TO TREAT GOUT 2.1 NON-OPIOIDS Allopurinol 100mg tablet 0.02 doctors Aspirin 300mg tablet Yes 0.01 Ibuprofen 400mg tablet Yes 0.01 Paracetamol 500mg tablet Yes 0.01 Paracetamol 500mg Suppos ICU only 0.95 Paracetamol 250mg Suppos Paed, ICU use only 0.1 Paracetamol 120mg/5ml elixir 0.42 Probenecid 500mg tablet 0.1 Reduced usage Diclofenac 25mg tablets donation Colchine 600mcg tablets donation 2.2 OPIOID ANALGESICS Codeine 30mg tablet Yes 0.07 Fentanyl 100mcg/2ml injection 0.73 Morphine 10mg/ml injection Yes 0.34 Pethidine 50mg/ml injection O&G only 0.3 Morphine 10mg tablets SR Morphine 30mg tablets SR 3 ANTI-ALLERGICS & DRUGS USED IN ANAPHYLAXIS Adrenaline 1mg/ml injection Yes 0.43 Chlorpheniramine 4mg tablet Yes 0.01 Dexamethasone 4mg/ml injection 0.2 Dexamethasone 500mcg tablet 0.07 Hydrocortisone sodium succinate 100mg injection 0.46 Promethazine 50mg/ml injection Yes 0.26 Promethazine 10mg tablets cheaper than prom 228

5 Page 229 of 401 Tuvalu Standard Treatment Guidelines ANTIDOTES & OTHER SUBSTANCES USED IN POISONINGS 4.1 GENERAL Charcoal and Sorbitol Soln Yes 2-3 for OPD 4.2 SPECIFIC Acetycysteine 200mg/ml injection 10ml Paracetamol OD only course only Atropine 1mg/ml injection 0.1 Naloxone 400mcg/ml injection ANTIEPILEPTICS Carbamazepine 200mg tablet Indiv patients 0.02 Diazepam 10mg/2ml injection Yes 0.15 Diazepam 5mg tablet Yes 0.01 Phenobarbitone 200mg injection Paed use 1.23 Phenytoin 250mg/5ml injection 2.88 Phenytoin 100mg tablet Yes 0.01 Sod.Valproate 150mg tablet Others ineffective ANTI-INFECTIVE DRUGS INTESTINAL ANTHELMINTICS Mebendazole 100mg tablet Yes 0.01 Pyrantel 250mg tablets ANTIFILARIALS Albendazole 400mg tablet Diethylcarbamazine 50mg tablet Yes - campaign Yes - campaign WHO Filiariasis WHO Filiariasis 6.2 ANTIBACTERIALS Penicillins Amoxycillin 250mg tablet?capsules Yes 0.02 Amoxycillin 500mg/Clavulanic acid 125mg tablet Resistant cases only 0.24 Amoxycillin 125mg/5ml Susp 0.56 Ampicillin 1g injection 0.18 Benzathine penicillin 1.2 mega injection 0.16 Benzyl penicillin 600mg injection Yes 0.08 Fluc/Cloxacillin 500mg injection 0.23 flucloxacillin alt Cloxacillin 250mg tablet Yes 0.02 Replaces fluclox Cloxacillin 500mg capsules Yes Phenoxymethylpenicillin 250mg tablet Yes 0.03 Replaces syrup Procaine penicillin 4mega injection Yes Other Antibacterials Azithromycin 250mg/500mg tablet STI for chlymydia 0.42 Stat dose 229

6 Page 230 of 401 Tuvalu Standard Treatment Guidelines 2010 Ceftriaxone 1g injection For resistant organisms 1.72 Chloramphenicol 250mg capsule 0.02 Chloramphenicol 1g injection 0.58 Chloramphenicol 125mg/5ml suspension 1.88 on doctosrs Keep as only caps STI for gonorrhoea 0.07 Stat dose Ciprofloxacin 500mg tablet Co-trimoxazole 480mg tablet Yes 0.01 delete syrup Doxycycline 100mg tablet / capsule Yes 0.02 Erythromycin 250 tablet 0.12 Syrup deleted Gentamicin 80mg/2ml injection 0.08 Metronidazole 5mg/ml IV solution 100ml 1.3 Metronidazole 200mg tablet Yes 0.01 MTZ Syrup del Tinidazole 500mg tablet Yes 0.04 Stat dose MTZ Vancomycin 250mg injection Restricted item Low doses only Antileprosy drugs Clofazimine 50mg tablet Dapsone 100mg tablet Rifampicin 150mg/300mg capsule only combipacks only combipacks only combipacks Free WHO Free WHO Free WHO - need PB? combipacks only Free from WHO Anti-tuberculosis drugs Ethambutol 400mg tablet Yes, indiv patients TB 0.05 Yes, indiv Isoniazid 100mg tablet patients 0.02 Yes, indiv Pyrazinamide 4/500mg tablet patients TB 0.05 Yes, indiv Rifampicin 150mg tablet / capsule patients 0.05 Yes, indiv Rifampicin 150mg/Isoniazid 75mg tablet patients TB 0.04 Streptomycin 1g injection TB Antiviral Drugs Aciclovir 200mg tablet Severe herpes 0.03 Aciclovir Eye Ointment Herpes of eye 0.56 HIV Drugs - as per Global Fund HIV/AIDS Free doctors only doctors only Global Fund pays 6.3 ANTIFUNGAL DRUGS Clotrimazole 500mg Pessary Yes 1.32 stat dose fluconazole 50mg tabets 0.34 Griseofulvin 500mg tablet 0.04 only Nystatin oral suspension 100,000 units

7 Page 231 of 401 Tuvalu Standard Treatment Guidelines ANTIPROTOZOAL DRUGS Antiamoebic Where oral not possible 1.3 Metronidazole 5mg/ml IV solution 100ml Metronidazole 200mg tablet Yes 0.01 Tinidazole 500mg tablet Yes 0.04 Stat dose Metronidazole suppos 500mg Antimalarial Drugs Chloroquine 150mg base tablet 0.01 Doxycycline 100mg tab/cap 0.02 Fansidar tablet P.falciparum 0.05 Primaquine 15mg tablet P.vivax eradication 0.02 for indiv patient Quinine 300mg/ml injection Cerebral malaria 0.23 Quinine sulphate 300mg tablet ANTI-MIGRAINE DRUGS 7.1 FOR TREATMENT Aspirin 300mg tablet Yes 0.01 Chlorpromazine 50mg injection 0.19 Low dose only Metoclopramide 10mg injection 0.15 Paracetamol 500mg tablet Yes FOR PROPHYLAXIS Propranolol 10mg tablet Thyroid storm mg deleted Propranolol Injection or similar Thyroid storm 0.67?supplier 8 ANTINEOPLASTICS & IMMUNOSUPPRESSANTS 8.1 IMMUNOSUPPRESSIVE DRUGS Dexamethasone 500mcg tablet 0.07 not 2mg,4mg Prednisolone 5mg tablet 0.01 Not prednisone 8.2 ANTINEOPLASTIC DRUGS Cyclophosphamide injection Indiv patients 7.68 Drug Comm 5-Fluorouracil 500mg injection Indiv patients 7.34 Drug Comm Methotrexate 50mg injection Indiv patients 5.56 Drug Comm Methotrexate 2.5mg tablets Indiv patients HORMONES AND ANTI_HORMONES Tamoxifen 10/20mg tablet Indiv.patients ANTIPARKINSONIAN DRUGS Benzhexol 2mg tablet DRUGS AFFECTING THE BLOOD 10.1 ANTI-ANAEMIA DRUGS Ferrous sulphate 200mg tablet

8 Page 232 of 401 Tuvalu Standard Treatment Guidelines 2010 Ferrous sulphate/gluconate syrup preps. >1yr 5.54/100ml for outer islands Ferrous sulphate 200mg + folic acid 0.25mg tablet Yes 0.01 Fe Dextran 5% Inj Folic acid 5mg tablet 0.01 Small supply Hydroxocobalamin 1mg injection DRUGS AFFECTING COAGULATION Heparin sodium 5000iu/ml 5ml injection 1.53 Phytomenadione 1mg in 0.5ml injection Yes mg deleted Warfarin 1mg tablet individual cases only 0.04 Keep same brand Warfarin 3mg tablet individual cases only 0.06 Delete 2mg Warfarin 5mg tablet individual cases only BLOOD PRODUCTS & PLASMA SUBSTITUTES Polygeline IV solution 500ml (Haemacel/Gelofusine) CARDIOVASCULAR DRUGS 12.1 ANTI-ANGINAL DRUGS Atenolol 50mg tablet 0.02 Glyceryl trinitrate 600mcg tablet Yes 0.06 Isosorbide dinitrate 10mg tablet 0.01 doctors Nifedipine 20mg SR tablet Yes 0.01 doctors Propranolol 10mg tablet 0.01 change from 40mg Verapamil 40mg tablet ANTI ARRHYTHMIC DRUGS Atenolol 50mg tablet 0.02 Lignocaine 2% injection 10ml 0.42 Propranolol 10mg tablet 0.01 Verapamil 2.5mg/ml injection 2.7 Verapamil 40mg tablet 0.05 Amiodarone 50mg/ml injection small amount 12.3 ANTIHYPERTENSIVE DRUGS Atenolol 50mg tablet 0.02 Enalapril 5mg tablets Indiv patient 0.02 Hydralazine 20mg/ml injection 7.16 Tabs deleted Hydrochlorothiazide 25mg tablet Indiv patient 0.01 Methyldopa 250mg tablet Indiv patient 0.05 Nifedipine 20mg ST tablet Indiv patient 0.01 Prazosin 2mg tablet BPH 232

9 Page 233 of 401 Tuvalu Standard Treatment Guidelines 2010 treatment Propranolol 10mg tablet Thyroid storm DRUGS USED IN HEART FAILURE Digoxin 500mcg/2ml injection 1.72 Digoxin 250mcg tablet 0.04 Enalapril 5mg tablet 0.02 Isosorbide dinitrate 10mg tablet DRUGS USED IN VASCULAR SHOCK Adrenaline 1mg/ml injection 0.43 Ephedrine 30mg/ml injection ANTITHROMBIC DRUGS Aspirin 300mg tablet 0.01 Streptokinase 1,500,000 units injection Documented MI 82 Keep 1-2 only 12.9 LIPID LOWERING AGENTS Simvastatin 20mg tablets Indiv patients Drug Comm 13 DERMATOLOGICAL DRUGS 13.1 ANTFUNGAL DRUGS (TOPICAL) Compound benzoic + salicylic acid oint (Whitfields) Yes 1.1/50g Salicylic acid 10% lotion Yes Miconazole cream 2% Yes ANTI-INFECTIVE DRUGS Neomycin + bacitracin + polymyxin ointment Yes 0.63 Silver sulphadiazine 1% cream Yes 0.67/50g Chlorhexidine 1% Cream Yes Order 50g packs 13.3 ANTI-INFLAMMATORY & ANTI-PRURITIC DRUGS Betamethasone 0.1% cream 0.7 Hydrocortisone 1% cream Yes 0.51 Zinc Oxide oint Yes SCABICIDES AND PEDICULOCIDES Benzyl benzoate 25% lotion Yes 4.42/1L Permethrin Lotion Yes Child, 3.67/100ml pregnant women 13.6 OTHER DERMATOLOGICAL PREPARATIONS Lubricating Jelly DIAGNOSTIC AGENTS 233

10 Page 234 of 401 Tuvalu Standard Treatment Guidelines 2010 OPHTHALMIC DRUGS Fluorescein ophthalmic strips 64/100 Tropicamide 1% Drops IMMUNOLOGICAL AGENTS PPD Human Tuberculin 100U/ml Radiocontrast media consult Barium sulphate aqueous solution radiographer 14.3 OTHER AGENTS ECG Electrode Gel 3.34 Ultrasound Gel 15 DISINFECTANTS & ANTISEPTICS Calcium hypochlorite/milton for solution Chlorhexidine 1.5% + cetrimide 15% conc. Yes 3.3/500ml Chlorhexidine 1% cream Yes 3.5/500g Hydrogen peroxide 3% solution 1.27/100ml Methylated spirits 70% SVM Povidine iodine 10% aqueous solution Yes 6.97/500ml 16 DIURETICS Acetazolamide 250mg tablet Glaucoma 0.04 Frusemide 20mg/2ml injection 0.26 Frusemide 40mg tablet Yes 0.01 Hydrochlorothiazide 25mg tablet Yes 0.01 Mannitol 20% injection 3.25 Spironolactone 25mg tablet GASTROINTESTINAL DRUGS 17.1 ANTACIDS & OTHER ANTIULCER DRUGS Magnesium trisilicate compound tablet Yes 0.01 Omeprazole 20mg capsule 0.02 Ranitidine 50mg injection ICU& OI use only 0.38 Ranitidine 300mg tablets doctors only 17.2 ANTIEMETIC DRUGS Metoclopramide 10mg/2ml injection 0.09 Metoclopramide 10mg tablet 0.01 Prochlorperazine 12.5mg/ml injection 0.51 Promethazine 50mg injection 0.26 Prochlorperazine 5mg tablets Promethazine tablets 10mg 17.3 ANTIHAEMORRHOIDAL DRUGS Haemorrhoidal ointment Yes ANTISPASMODIC DRUGS Hyoscine N Butylbromide 20mg injection

11 Page 235 of 401 Tuvalu Standard Treatment Guidelines 2010 Hyoscine N Butylbromide 10mg tablet LAXATIVE DRUGS Bisacodyl 10mg suppository 0.1 Bisacodyl 5mg tablet 0.01 Xray Prep Kits 17.7 DRUGS USED IN DIARRHOEA Codeine phosphate 30mg tablet Yes 0.07 Oral rehydration salts Yes 0.11 Zinc sulphate 10mg tablet HORMONES, OTHER ENDOCRINE DRUGS & CONTRACEPTIVES ADRENAL HORMONES & SYNTHETIC SUBSTITUTES Dexamethasone 500mcg tablet 0.07 Hydrocortisone sodium succinate 100mg injection 0.46 Prednisolone 5mg, 20mg tablet CONTRACEPTIVES Hormonal contraceptives Ethinyloestradiol 30mcg + levonorgestrel 150mcg (Microgynon) Yes UNFPA Eugynon deleted Levonorgestrol 750mcg tablet (Postinor) UNFPA On doctors Levonorgestrel 30mcg (Microlut) Yes UNFPA Provera 10mg del Medroxyprogesterone acetate 150mg/ml injection Yes UNFPA Progest Inj del UNFPA donation Medroxyprogesterone acetate implant (norplant) UNFPA Medroxyprogesterone tablets Yes Intrauterine Devices Copper-containing IUD UNFPA Premarin donation Barrier Methods Condoms with or without spermicide (nonoxicol) Yes UNFPA Male & Female condoms Yes UNFPA 18.4 Insulins and other Antidiabetic Agents Glibenclamide 5mg tabs Yes 0.01 Glipizide 5mg tablet renal pts 0.03 Insulin soluble 100IU/ml 10ml 12.4 Doctors Insulin Isophane 100IU/ml 10ml Yes 12.4 Mixtard if needed/doctors Metformin 500mg tablet Yes OVULATION INDUCERS Clomiphene 50mg tablet O&G only 235

12 Page 236 of 401 Tuvalu Standard Treatment Guidelines PROGESTERONES Norethisterone 5mg tablet THYROID HORM & ANTITHYROID DRUGS Carbimazole 5mg tablet 0.02 Thyroxine 100mcg tablet OTHER Finasteride 5mg tablet Indiv pat only 1.2 Very expensive 19 IMMUNOLOGICALS 19.1 SERA & IMMUNOGLOBULINS HBV immunoglobulin 400U/ml 19.2 For universal immunisation BCG Vaccine Yes Pub Health DPT Vaccine Yes Pub Health Hepatitis B Vaccine Yes Pub Health Measles-Rubella Yes Pub Health Polio (Sabin) Yes Pub Health Tetanus Toxoid Adsorbed Yes Pub Health Pentavac(Hep B/Hib/HBV) Pub Health MUSCLE RELAXANTS(PERIPHERALLY ACT) & C'ESTERASE INHIBITORS small supply only Atracurium 25mg/2.5ml injection 6.77 Neostigmine 2.5mg injection 0.47 Suxamethonium 100mg/2ml injection 0.55 Pancur deleted Vecuronium 10mg injection 5.56 OPTHALMOLOGICAL & ENT PREPARATIONS 21.1 ANTI-INFECTIVE AGENTS Aciclovir Eye Ointment Ocular herpes 0.56 Chloramphenicol 5% ear drops Yes 0.59 Chloramphenicol 0.5% eye drops Yes 0.38 Chloramphenicol 1% eye ointment Yes 0.3 Gentamicin 0.3% eye drops 0.58 Tetracycline 1% eye ointment Yes 0.18 Gentamicin ear drop Antifungal ear drops 21.2 ANTI-INFLAMMATORY AGENTS Dexamethasone 1mg/ml eye drops 1.83 Prednisolone eye drops 21.3 LOCAL ANAESTHETICS Amethocaine 0.5% eye drops

13 Page 237 of 401 Tuvalu Standard Treatment Guidelines MIOTICS & ANTIGLAUCOMA DRUGS Acetazolamide 250mg tablets 0.04 Pilocarpine 2% eye drops 1.28 Timolol - indiv.pat 21.5 MYDRIATICS Tropicamide 1% eye drops 1.05 Phenylephrine 10% Drops/Minims OXYTOCICS & ANTIOXYTOCICS 22.1 OXYTOCICS Ergometrine 500mcg + oxytocin 5iu injection Yes 1.84 Oxytocin 10iu injection Yes 0.23 Misoprostol 200mcg tablet O&G only ANTIOXYTOCICS Nifedipine 20mg SR tablet Yes 0.01 Salbutamol 500mcg/ml injection PYSCHOTHERAPEUTIC DRUGS Amitriptylline 25mg tablets 0.01 Chlorpromazine25mg tablets 0.02 Chlorpromazine 50mg injection Diazepam 5mg tablets Yes 0.01 Fluphenazine Depot 25mg/ml injection Indiv patient 0.99 Haloperidol 5mg injection 0.33 Haloperidol tablets 500mcg DRUGS ACTING ON THE RESPIRATORY TRACT Adrenaline 1mg/ml injection Yes 0.43 Del theophylline Aminophylline 250mg/10ml injection 0.72 Beclomethasone 50/100mcg inhaler 4.42 Del Beconase Salbutamol 100mcg Inhaler Yes 2.16 Salbutamol 5mg/ml Resp.Soln 30ml 5.75 Salbutamol 500mcg/ml injection 0.1 Salbutamol 4mg tablet 0.01 SOLNS CORRECTING WATER, ELECTROLYTE & ACID BASE DISTURB Delete Fenoterol Delete over time, encourage spray 25.1 ORAL Oral rehydration salts Yes 0.11 Potassium chloride SR 600mg tablet 0.01 Limit supply Sod.citrotartrate sachets (Ural) 25.2 PARENTERAL 237

14 Page 238 of 401 Tuvalu Standard Treatment Guidelines 2010 Calcium gluconate 100mg/ml 3.62 Compound solution of sodium lactate (Hartmanns) 1L Yes 1.3 Dextrose 10% injection 1L O&G/neonatal use doctors advice only Dextrose 5% 1L Yes 1.3 Dextrose 50% 50ml 1.5 Dextrose 3% in 1/3 NS 1L 1.4 Gelofusine Plasma Expander 500ml 5.93 Magnesium Sulphate 50% injection Eclampsia 1.33 Mannitol 20% 500ml 3.25 Potassium chloride 1.5g/10ml 0.5 Sodium bicarbonate 8.4% 10ml 0.86 Sodium chloride 0.9% 1L Yes 1.3 Water for injection 10ml Yes 0.07 Keep only 10ml 26 VITAMINS & MINERALS Hydroxocobalamin 1mg/ml injection (VitB12) 0.45 Multivitamin tablet Yes 0.01 Pyridoxine 50mg tablet 0.02 Phytomenadione 1mg in 0.5ml injection (Vit K1) Yes 0.3 Vitamin B1 inj ESSENTIAL MEDICINES FOR CHILDREN TUVALU ESSENTIAL MEDICINE LIST FOR CHILDREN WHO Drug name, strength and dosage form Outer Restrict use Cost $A COMMENTS Island 1 ANAESTHETICS 1.1 GENERAL ANAESTHETICS Ketamine injection 50mg (as HCL)/ml in 10ml Nitrous oxide inhalation Oxygen Thiopental injection 0.5g Fentanyl 100mcg/2ml injection Isophane/Halothane inhalation Anaesthetist use only Anaesthetist use only Anaesthetist use only Anaesthetist use only Anaesthetist use only 238

15 Page 239 of 401 Tuvalu Standard Treatment Guidelines LOCAL ANAESTHETICS Bupivacaine plain injection 0.5% Lignocaine 1% plain injection Lignocaine 2% + adrenaline 1:80,000 dental cartidege Lignocaine pump Lignocaine gel 1.3 PRE-OPERATIVE MEDICATION Atropine 600mcg injection Diazepam injection 5mg/2ml Diazepam tablets 5mg Morphine (SO2/HCL) injection 10mg Midazolam 15mg/2ml injection Ketamine injection 50mg (as HCL)/ml in 10ml Chloral hydrate 100mg/ml mixture dentist advice use ANALGESICS, ANTIPYRETICS, NSAID's, 2 DRUGS TO TREAT GOUT 2.1 NON-OPIOIDS Ibuprofen tablets 200mg Paracetamol Oral liquid 120mg/5ml Paracetamol Suppository 100mg Paracetamol tablets 500mg Aspirin tablets 100mg 2.2 OPIOID ANALGESICS Morphine injection 10mg Morphine Oral (HCL/SO4) liquid 10mg Morphine 10mg tablets SR Use for rheumatic fever, juvenile athritis, kawasaki disease Use >3months 100mg if can source 3 ANTI-ALLERGICS & DRUGS USED IN ANAPHYLAXIS Chlorpheniramine injection 10mg/ml Chlorpheniramine tablet 4mg Use >1yr Dexamethasone (HCL) injection 4mg/ml Adrenaline 1mg/ml Hydrocortisone 100mg/ml (sodium succinate) Prednisolone oral liquid 5mg/ml 239

16 Page 240 of 401 Tuvalu Standard Treatment Guidelines 2010 ANTIDOTES & OTHER SUBSTANCES USED 4 IN POISONINGS 4.1 GENERAL charcoal activated powder 4.2 SPECIFIC Acetylcysteine injection 200mg/ml Atropine injection 1mg/ml Calcium gluconate 100mg/ml 5 ANTICONVULSANTS/ANTIEPILEPTICS Carbamazepine oral liquid 100mg/5ml Carbamazepine (chewable) 100mg tablet Diazepam injection 5mg/ml Phenobarbitone injection 200mg/ml Phenytoin injection 50mg/ml Phenytoin Oral liquid 25mg/ml Valproic acid tablet (crushable) 100mg Phenobarbitone 3mg/ml oral liquid as sodium valproate 6 ANTI-INFECTIVE DRUGS INTESTINAL ANTHELMINTICS Pyrantel Oral liquid 50mg/ml as embolate Mebendazole tablets 100mg ANTIFILARIALS WHO Filarisis Albendazole tablets 400mg prog WHO Filarisis Diethylcarbamazepine tablet 50mg prog 6.2 ANTIBACTERIALS Beta lactam medicines Amoxycillin oral liquid 125mg/5ml (powder for liq) Amoxycillin capsules 250mg Ampicillin injection 500mg Benzathine benzylpenicillin inject.900mg (1.2mIU) Benzylpenicillin injection 600mg Cloxacillin oral liquid 125mg/5ml Cloxacillin injection 500mg Cloxacillin capsules 500mg Phenoxylmethylpencillin oral liq. 125mg/5ml Procaine Benzylpenicillin inj. 1g (1mIU) Not recom. As 1st line for neonatal sepsis 240

17 Page 241 of 401 Tuvalu Standard Treatment Guidelines Other Antibacterials chloramphenicol Oral liquid 150mg/5ml as palmitate chloramphenicol capsules 250mg Doxycycline Oral liquid 25mg/ml Doxycycline capsules 100mg Erythromycin oral liquid 125mg/5ml as stearate/ethyl succinate Erythromycin tablets 250mg as stearate/ethyl succinate Gentamicin injection 40mg (as sulphate) Metronidazole injection 500mg Metronidazole oral liquid 200mg/5ml as benzoate Sulfamethoxazole + trimethoprim Oral Liq. 240mg/5ml Antileprosy drugs Dapsone tablets 25mg Rifampicin tablets 150mg Clofazimine capsules 50mg Anti-tuberculosis drugs Ethambutol tablet 100mg Isoniazid tablet (scored) 100mg tablet Pyrazinamide (dispersable) 150mg tablet Rifampicin tablet 150mg Antiviral Drugs As per Global Fund WHO tb Program Global fund Global fund Global fund Global fund Global fund Global fund Global fund Global fund Global fund Global fund Global fund 6.3 ANTIFUNGAL DRUGS Fluconazole 50mg tablet Griseofulvin tablet 125mg Nystatin Oal liquid 100,000IU/ml 6.4 ANTIPROTOZOAL DRUGS Antiamoebic Metronidazole injection 500mg Metronidazole oral liquid 200mg/5ml as benzoate Antimalarial Drugs Chloroquine 50mg capsule Doxycycline capsule 100mg 241

18 Page 242 of 401 Tuvalu Standard Treatment Guidelines 2010 Primaquine tablet 7.5mg Quinine HCL injection 300mg/ml 7 ANTI-MIGRAINE DRUGS 7.1 FOR TREATMENT Ibuprofen tablet 400mg Paracetamol 120mg/5ml Oral liquid ANTINEOPLASTICS & 8 IMMUNOSUPPRESSANTS 8.1 IMMUNOSUPPRESSIVE DRUGS Azathioprine injection 100mg Ciclosporin capsule 25mg 8.2 ANTINEOPLASTIC DRUGS Allopurinol tablet 100mg Asparaginase injection IU Bleomycin injection 15mg Methotrexate injection 50mg 8.3 HORMONES AND ANTI_HORMONES Dexamethasone injection 4mg Hydrocortisone injection 100mg Prednisolone oral liquid 5mg/ml as disodium salt 9 Medicines used in palliative care Amitriptylline tablet 10mg Dexamethasone injection 4mg Diazepam injection 5mg/ml Hyoscine hydrobromide injection 400mcg/ml Midazolam injection 1mg/ml Mophine tablet 10mg SR Senna oral liquid 7.5mg/ml 10 MEDICINES AFFECTING THE BLOOD 10.1 ANTI-ANAEMIA DRUGS Ferrous sulphate oral liquid 25mg/ml as sulphate Folic acid tablet 5mg Hydroxycobalamin injection 1mg/ml 10.2 DRUGS AFFECTING COAGULATION Phytomenadione injection 1mg/ml Heparin sodium injection 1000IU/ml 11 CARDIOVASCULAR DRUGS Requesting review whether or not these 11.1 medicines 11.2 ANTI ARRHYTHMIC DRUGS 242

19 Page 243 of 401 Tuvalu Standard Treatment Guidelines 2010 Digoxin 250mg/ml injection Lignocaine 2% injection Propranolol 10mg tablet 11.3 ANTIHYPERTENSIVE DRUGS Enalapril tablet 5mg 11.4 DRUGS USED IN HEART FAILURE Digoxin injection 250mcg/ml Digoxin tablets 250mcg Frusemide oral liquid 20mg/5ml Frusemide injection10mg/ml 12 DERMATOLOGICAL DRUGS 12.1 ANTFUNGAL DRUGS (TOPICAL) Benzoic acid+salicylic acid cream/ointment Miconazole cream 2% 12.2 ANTI-INFECTIVE DRUGS Neomycin sulphate + bacitracin Silver sulphadizine cream 1% 12.3 ANTI-INFLAMMATORY & ANTI-PRURITIC DRUGS Betamethasone cream/ointment 0.1% Calamine lotion Hydrocortisone 1% cream/lotion 12.4 SCABICIDES AND PEDICULOCIDES Permethrin cream 5% 13 DIAGNOSTIC AGENTS OPHTHALMIC DRUGS Tropicamide eye drops 0.5% 13.1 Radioconrtast media Barium sulphate aqueuos solution Doctor supervision 13.2 IMMUNOLOGICAL AGENTS PPD Human Tuberculin DISINFECTANTS & ANTISEPTICS Chlorhexidine solution 5%(digluconate) Ethanol solution 70%(denatured) Povisone iodine aquous 10% 15 DIURETICS Frusemide injection 10mg/ml 243

20 Page 244 of 401 Tuvalu Standard Treatment Guidelines 2010 Frusemide oral liquid 20mg/5ml Frusemide tablet 40mg 16 GASTROINTESTINAL DRUGS 16.1 ANTACIDS & OTHER ANTIULCER DRUGS Aluminium hydroxide oral liquid 320mg/5ml Magnesium hydrochloride oral liquid Ranitidine (as HCL) tablet 150mg Metoclopramide oral liquid 5mg/5ml Dimenhydrinate oral liquid 2.5mg/ml eq. to 550mg MgO2/10ml 16.2 ANTIEMETIC DRUGS Metoclopramide tablet 10mg doctors Not for neonatal use 16.3 LAXATIVE DRUGS Bisacodyl suppository 10mg Glycerine suppository 16.4 DRUGS USED IN DIARRHOEA Oral rehydration salts Zinc sulphate tablet 10mg In acute diarrhoea zinc sulphate should be used as an adjunct to ORS HORMONES, OTHER ENDOCRINE DRUGS & CONTRACEPTIVES ADRENAL HORMONES & SYNTHETIC SUBSTITUTES prednisolone 5mg Hydrocortisone injection 100mg as sodium succinate 17.2 Insulins and other Antidiabetic Agents Insulin soluble 100IU/ml 10ml Insulin isophane 100IU/ml 10ml 17.3 THYROID HORM & ANTITHYROID DRUGS Levothyroxine tablet 50mcg small amount 244

21 Page 245 of 401 Tuvalu Standard Treatment Guidelines IMMUNOLOGICALS 18.1 SERA & IMMUNOGLOBULINS HBV immunoglobulin 400U/ml 18.2 For universal immunisation BCG Vaccine Yes Pub Health DPT Vaccine Yes Pub Health Hepatitis B Vaccine Yes Pub Health Measles-Rubella Yes Pub Health Polio (Sabin) Yes Pub Health Tetanus Toxoid Adsorbed Yes Pub Health Haemphilus influezae type b vaccine Yes Pub Health 19 MUSCLE RELAXANTS(PERIPHERALLY ACT) & C'ESTERASE INHIBITORS Neostigmine injection 500mcg/ml Suxamethonium injection 50mg Vercuronium injection 10mg Anaesthetist advice Anaesthetist advice Anaesthetist advice 20 OPTHALMOLOGICAL & ENT PREPARATIONS 20.1 ANTI-INFECTIVE AGENTS Aciclovir ointment 3%w/w Gentamicin solution eye drops 0.3% (sulphate) Chlorampenicol eye drops Chlorampenicol eye ointment 20.2 ANTI-INFLAMMATORY AGENTS Prednisolone solution eye drops 0.5% (sod.phos) 20.3 LOCAL ANAESTHETICS Amethocaine 0.5% eye drops Specialist use Specialist use 21 PYSCHOTHERAPEUTIC DRUGS Chlorpromazine injection 25mg Chlorpromazine tablet 10mg Haloperidol tablet 0.5mg Specialist use Specialist use Specialist use 22 DRUGS ACTING ON THE RESPIRATORY TRACT Adrenaline injection 1mg/ml Salbutamol injection 50mcg Salbutamol meter dose inhaler 100mcg/dose Salbutamol oral liquid 2mg/ml Salbutamol solution for use in nebulizer 5mg/ml Salbutamol tablet 5mg Ipratropium meter dose inhaler 20mcg/dose doctors advice Ipratropium solution for nebulizer 250mcg/ml Beclomethasone meter dose inhaler 245

22 Page 246 of 401 Tuvalu Standard Treatment Guidelines 2010 SOLNS CORRECTING WATER, 23 ELECTROLYTE & ACID BASE DISTURB 23.1 ORAL Oral rehydration salts Potassium chloride 23.2 PARENTERAL Glucose 5% injectable solution Infusion pumps Glucose with sodium chloride inj. Solution 5%/0.9% to be used on Potassium chloride solution 7.5% doctors advice Sodium chloride inj. 0.9% solution Water for injections 2ML Dextrose 10% injectable solution 24 VITAMINS & MINERALS Ascorbic acid tablets 50mg Cholcalciferol tablet 400IU Iodine capsule 200mg Pyridoxine (HCL) tablet 25mg Multivitamin syrup Thiamine tablet 50mg 25 EAR, NOSE AND THROAT CONDITION IN CHILDREN Acetic acid topical 2% in alcohol Wax Removal ear drops Budesonide nasal spray 100mcg/spray Specialist use 246

23 Page 247 of 401 Tuvalu Standard Treatment Guidelines 2010 References 1. Tonga Standard Treatment Guidelines Fiji Standard Treatment Guidelines: -Respiratory -Cardiovascular -Antibiotics Managing diates mellitus 3. AMH WHO Model list for Essential Medicines unedited version WHO Model List for Essential Medicines for children unedited version

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