Download - MOH KS management guidelines
MOH KS management guidelines
Jane BatesTiyanjane Clinic, QECH
October 2009
Criteria for vincristine
Tested for HIV
advanced and / or progressive disease (check FBC)- consider vincristine
Clinical diagnosis of KS
On ARVs for at least 3 months
improving and / or stable disease - hold vincristine
High priority Medium Priority consider continue ARVSmay start before unilat or biilat. leg if exclusions 3 months ARVs completed KS limiting function apply confirmed or suspected oral lesions Pulmonary KS rapidly progressive maintain pain anddisease Involving face symptom control
ExclusionsAbsolute • severe peripheral neuropathy • unable to travel – financial or physical constraints• Hb < 8, platelet < 150• severe liver disturbance/diseaseRelative • near to another hospital site delivering
chemotherapy• minimal disease
2mg × six doses weeklySix week review If ‘no effect’, side effects and /or
limited stable disease - discontinueIf ‘good effect’, minimal side
effects and residual disease – continue
2mg × six doses fortnightly Review (as for six week review)2mg × six doses monthlyReview at end of schedule+ Review 3 months post treatment
Initial assessment visit
Pain and symptom control
• Assess and treat pain according to WHO analgesic ladder
• Salicylic acid cream/antihistamines for itching• Crushed metronidazole to reduce smell• potassium permanganate soaks to dry excess
oozing• Wound care, nutrition assessment and advice
WHO 3-stepLadder
1 mild1 mild
2 moderate2 moderate
3 severe3 severe
Morphine
± step 1 and/or Adjuvants
Morphine
± step 1 and/or Adjuvants
A/Codeine
A/Dihydrocodeine
Tramadol
± step 1 and/or Adjuvants
A/Codeine
A/Dihydrocodeine
Tramadol
± step 1 and/or Adjuvants
Aspirin
Paracetemol
NSAIDs
± Adjuvants
Aspirin
Paracetemol
NSAIDs
± Adjuvants
Drug type Drug name Dosage
(max daily dose)
Non opioids Paracetamol
Indomethacin
Aspirin
Brufen
1g qds (4g)
50mg tds (200mg)
300-900mg qds (4g)
400mg tds (2.4g)
Weak opioids Codeine
Dihydrocodeine
Compound preps
tramadol
30-60mg 4 hrly (240mg)
30mg 4-6 hrly (360mg)
2 tablets qds
50mg tds (400mg)
Strong opioids
Note : Pethidine is no longer recommended for treatment of chronic pain
Morphine Oral morphine solution, start at 2.5-5mg 4 hrly
MST, calculate according to need of oral solution (or start 10mg bd)
Other issues to consider
• This treatment regime is not curative• Patients/guardians need counselling about nature of
disease to assist with having realistic expectations• A major part of management is managing expectations
of patients, so information needs to be clear, consistent and honest
• At Tiyanjane we use a Chichewa information sheet for literate patients (double side A4) which you can have a copy of. If its of use photocopy and give out.
• If vincristine is not helping don’t continue it, aim for patient comfort and quality of life