Download Management of Infections - Department of Health WA

Humanitarian Entrant Health Service
Management of Infections
Reference: HEHS 3.1
Issued: July 2011
Review date: July 2016
As a general principle, for treatment of all infectious diseases in
humanitarian entrants, Humanitarian Entrant Health Service (HEHS) the
Medical officers should adhere to the following evidence-based
guidelines for treatment;
1. Diagnosis, management and prevention of infections in recently
arrived refugees, Australasian Society for Infectious Disease, 2009.
Accessed at http://www.asid.net.au/downloads/RefugeeGuidelines.pdf
2. Therapeutic Guidelines: Antibiotic (Therapeutic Guidelines Ltd: North
Melbourne, available at Department of Health WA library
http://www.library.health.wa.gov.au/corporate/resources/resource.cfm
3. Australian Medicines Handbook, available Department of Health WA
library;
http://www.library.health.wa.gov.au/corporate/resources/resource.cfm
Specific Considerations
Empirical Treatment for Helminths
• Albendazole 400mg oral stat (200mg oral stat for patients <=10kg)
should be offered to all patients over 2 years of age, excluding those
who are in the first trimester of pregnancy or who are breastfeeding as it
is safe and effective against Ascaris lumbricoides, Trichuris trichiuria,
Ancylostoma duodenale, Necator americanus, Giardia intestinalis,
Opisthorchis viverrini, Taenia solium and Hymenolepis nana.
• Albendazole is a category D drug. Women who are within the first
trimester of pregnancy, likely to become pregnant within one month, or
breastfeeding can be offered Pyrantel 20mg/kg oral stat max 750mg or
stool examination. Pyrantel is a category B2 drug, and the product
information recommends that it should be avoided during pregnancy
where possible. Therefore, the benefits of treating helminthic infection in
pregnancy with pyrantel, should be weighed up against the risks of
untreated helminthic infection to the mother and/or the unborn child.
Alternatively, a stool sample may be collected for microscopy prior to
treatment.
• Children two years of age or under can also be offered Pyrantel
20mg/kg oral stat, up to a max of 750mg.
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North Metropolitan Area Health Service: Public Health and Ambulatory Care
July 2011
Malaria
• Malarial infection in children, especially those under the age of 5
years should be considered a medical emergency;
• All children with malaria must be referred to the Paediatric Infectious
Diseases Physician or Fellow at Princess Margaret Hospital for Children
for urgent assessment and treatment;
• After hours, children with malaria may be referred to PMH
Emergency Department;
• Asymptomatic adults with low parasite load and normal indices on full
blood count should be referred to the nearest Infectious Diseases Clinic
for early outpatient appointment. Discuss with Infectious Diseases
registrar and fax/email referral letter;
• Symptomatic adults, pregnant women or adults with high parasite
load, anaemia or thrombocytopenia, require urgent assessment and
should be discussed with the Infectious Disease registrar/physician at
the appropriate hospital; and
• If the HEHS medical officer is unavailable, the HEHS nursing staff
should initiate the client referral to hospital on receipt of a positive
malaria result from the laboratory.
Notifications
• The HEHS medical officers are responsible for notifying
Communicable Disease Control of patients they find to have a notifiable
infectious disease.
Sexually Transmitted Infections
• Patients with uncomplicated sexually transmitted infections should be
treated in accordance with the Department of Health’s Guidelines for
Managing Sexually Transmitted Infections. Available here for download;
http://www.public.health.wa.gov.au/3/634/3/guidelines_for_.pm
Schistosomiasis
• See Appendix 1 for management of Schistosomiasis
References
1.
2.
3.
Muennig P et al. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. NEJM, Vol
340. No 10 March 1999
Australasian Society for Infectious Diseases; Diagnosis, Management and Prevention of Infections in recently arrived
refugees 2008
Therapeutic Guidelines: Antibiotic, Therapeutic Guidelines Ltd: North Melbourne
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North Metropolitan Area Health Service: Public Health and Ambulatory Care
July 2011
Appendix 1: Management of Schistosomiasis Algorithm
Patient with positive or borderline
positive schistosomiasis serology
Collect stool and urine specimen and treat
with Praziquantel x 2 doses 4 hours apart
(African 20mg/kg/dose, Asian 30mg/kg/dose)
Ova detected
Complicated infection
• Patient symptomatic
• Signs of chronic liver
disease
• Co-infection with
Hepatitis B or C
• Abnormal LFTs (ALT >
100)
Refer to Infectious Diseases
Physician
Uncomplicated infection
• Patient asymptomatic
• Clinical examination
normal
• LFTs normal
Ova not detected
No follow up
required
Letter for GP; follow up in 3
months to ensure cure
(if still positive, refer to
Infectious Diseases Clinic)
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North Metropolitan Area Health Service: Public Health and Ambulatory Care
July 2011