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Standard Treatment Guidelines for Common Illnesses - India.pdf

I am pleased to share a practical Standard Treatment Guidelines (STG) reference for common illnesses in India, designed to support healthcare professionals working at Primary and Secondary Care levels. The guideline is structured around a clear clinical pathway: Case Definition → Clinical Features → Investigations → Treatment → Referral Criteria → Prevention 🎯 The objective is to promote: Evidence-based and patient-centered clinical decision-making Standardized approaches to common conditions Appropriate investigation and treatment practices Timely identification of referral and emergency situations Prevention and continuity of care Quality improvement across healthcare facilities This resource is intended as a practical clinical reference, particularly for healthcare professionals serving communities where timely access to higher-level care may be challenging. ⚕️ Important: Pharmacological management should always be individualized and confirmed by a licensed physician according to the patient’s age, weight, comorbidities, clinical condition, and applicable national/local protocols. I welcome feedback, suggestions, and expert inputs from medical professionals, public health experts, nursing professionals, and healthcare administrators to further strengthen this resource.

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[Type here] Standards Treatment Guidelines - Dr J L Meena 1 Standard Treatment Guidelines Common Illnesses in India - Primary & Secondary Care Reference Structured per Case Definition → Clinical Features → Investigations → Treatment → Referral Criteria → Prevention All pharmacological management must be confirmed, individualized, and dosed by a licensed physician per patient age, weight, comorbidities, and current local/national protocol (NVBDCP, NTEP, NHM-STG, etc.). Prepared by: Dr. J. L. Meena
[Type here] Standards Treatment Guidelines - Dr J L Meena 2
[Type here] Standards Treatment Guidelines - Dr J L Meena 3 Table of Contents Section 1: Respiratory & Seasonal Illnesses ....................................................................... 5 Common Cold (Acute Viral Rhinitis) .............................................................................................5 Influenza-Like Illness (ILI) ............................................................................................................5 COVID-19....................................................................................................................................6 Sinusitis (Acute) ..........................................................................................................................6 Acute Tonsillopharyngitis ............................................................................................................7 Acute Bronchitis..........................................................................................................................7 Pulmonary Tuberculosis..............................................................................................................8 Community-Acquired Pneumonia ................................................................................................8 Section 2: Water- & Food-Borne Illnesses........................................................................... 9 Acute Diarrheal Disease ..............................................................................................................9 Cholera.......................................................................................................................................9 Typhoid Fever (Enteric Fever) .....................................................................................................10 Viral Hepatitis A / E....................................................................................................................10 Soil-Transmitted Helminthiasis .................................................................................................11 Food Poisoning..........................................................................................................................11 Section 3: Vector-Borne (Mosquito & Insect) Illnesses .......................................................12 Malaria .....................................................................................................................................12 Dengue Fever ............................................................................................................................12 Chikungunya.............................................................................................................................13 Lymphatic Filariasis ..................................................................................................................13 Japanese Encephalitis...............................................................................................................13 Section 4: Skin, Eye & Common Infections ........................................................................15 Dermatophytosis (Ringworm/Tinea) ...........................................................................................15 Scabies.....................................................................................................................................15 Urinary Tract Infection...............................................................................................................15 Acute Conjunctivitis ..................................................................................................................16 Varicella (Chickenpox)...............................................................................................................16 Section 5: Chronic & Lifestyle Conditions..........................................................................18 Type 2 Diabetes Mellitus............................................................................................................18 Hypertension ............................................................................................................................18 Bronchial Asthma......................................................................................................................19 Iron-Deficiency Anemia .............................................................................................................19
[Type here] Standards Treatment Guidelines - Dr J L Meena 4 Hypothyroidism.........................................................................................................................19 Gastro-Esophageal Reflux Disease (GERD)/Gastritis...................................................................20 Migraine....................................................................................................................................20 Hemorrhoids (Piles)...................................................................................................................21 Nephrolithiasis (Kidney Stones) .................................................................................................21 Section 6: Emergencies Requiring Immediate Referral.......................................................23 Quick First-Aid & Self-Care Reference...............................................................................24 References ......................................................................................................................25 Abbreviations ..................................................................................................................26 Important Notes...............................................................................................................28 (Right-click and choose “Update Field” if this appears blank when opened in Word)
[Type here] Standards Treatment Guidelines - Dr J L Meena 5 Section 1: Respiratory & Seasonal Illnesses Common Cold (Acute Viral Rhinitis) Case Definition Acute self-limiting viral infection of the upper respiratory tract Causes/Risk Factors Rhinovirus and other respiratory viruses; crowding, seasonal change, low immunity Clinical Features Nasal congestion, rhinorrhea, sneezing, mild sore throat, mild cough, low-grade or no fever Investigations Clinical diagnosis; investigations not routinely required Treatment Objectives Symptomatic relief; prevent secondary bacterial infection and spread Non-Pharmacological Management • Adequate rest and oral fluids • Steam inhalation 2-3 times/day • Warm saline gargles • Humidified air if dry climate Pharmacological Management • Paracetamol 500-650 mg PO every 6-8 hrs PRN for fever/aches (adult); max 4 g/day • Saline nasal drops/spray PRN • Antihistamine-decongestant combination PRN, per pharmacist/physician advice, avoid in young children without medical advice Referral Criteria Fever persisting beyond 3 days, breathing difficulty, ear pain, symptoms worsening after day 5 Prevention & Patient Education Hand hygiene, cough etiquette, avoid close contact with symptomatic individuals Influenza-Like Illness (ILI) Case Definition Acute respiratory illness with fever (≥38°C) and cough, of recent onset Causes/Risk Factors Influenza A/B virus; crowding, seasonal (monsoon/winter peak in India), extremes of age, comorbidities Clinical Features Sudden high fever, chills, severe myalgia, headache, dry cough, sore throat, fatigue Investigations Clinical diagnosis; RT-PCR/rapid antigen testing during outbreaks or in high-risk/severe cases Treatment Objectives Symptom control, prevention of complications (pneumonia), early identification of high-risk patients Non-Pharmacological Management • Complete rest, isolation 3-4 days from symptom onset • High oral fluid intake • Light, nutritious diet Pharmacological Management • Paracetamol for fever/myalgia (as above); avoid aspirin in children • Oseltamivir - only physician-prescribed, within 48 hrs of onset, for high-risk groups (elderly, pregnant, comorbid, severe illness) Referral Criteria Breathlessness, chest pain, cyanosis, altered sensorium, high fever beyond 3-4 days, high-risk patient with worsening symptoms
[Type here] Standards Treatment Guidelines - Dr J L Meena 6 Prevention & Patient Education Annual influenza vaccination for high-risk groups, hand hygiene, masking in crowded settings during outbreaks COVID-19 Case Definition Illness caused by SARS-CoV-2 infection, confirmed by RT-PCR/RAT or clinically suspected during outbreaks Clinical Features Fever, dry cough, sore throat, fatigue, loss of taste/smell, myalgia; wide severity spectrum Investigations RT-PCR or Rapid Antigen Test; pulse oximetry; chest imaging if indicated in moderate/severe disease Treatment Objectives Symptom relief in mild disease; early identification and escalation of moderate-severe disease Non-Pharmacological Management • Home isolation for mild cases per current government guidance • Rest, fluids • Twice-daily monitoring of temperature and SpO2 Pharmacological Management • Paracetamol for fever (as above) • Antivirals/steroids only under physician supervision for moderate-severe/high-risk cases • Hospital-based oxygen and supportive care for hypoxia Referral Criteria SpO2 <94%, persistent chest pain/pressure, altered mental status, cyanosis, breathlessness at rest Prevention & Patient Education Vaccination as per current national guidance, masking in crowded/poorly ventilated spaces, hand hygiene Sinusitis (Acute) Case Definition Inflammation of paranasal sinus mucosa, usually post-viral Clinical Features Facial pain/pressure, purulent nasal discharge, nasal obstruction, headache, reduced sense of smell Investigations Clinical diagnosis; imaging reserved for recurrent/complicated cases Treatment Objectives Symptom relief; treat bacterial superinfection where present Non-Pharmacological Management • Steam inhalation, warm facial compress • Saline nasal irrigation • Adequate hydration Pharmacological Management • Decongestant short-term (<5-7 days) PRN • Analgesic/antipyretic PRN • Antibiotics only if bacterial sinusitis confirmed by physician (symptoms >10 days or severe/worsening) Referral Criteria Periorbital swelling, severe headache, high fever, visual disturbance Prevention & Patient Education Treat allergic rhinitis/colds promptly, avoid smoke exposure
[Type here] Standards Treatment Guidelines - Dr J L Meena 7 Acute Tonsillopharyngitis Case Definition Acute inflammation of the pharynx/tonsils, viral or bacterial (Group A Streptococcus) Clinical Features Throat pain, odynophagia, tonsillar erythema/exudate, fever, cervical lymphadenopathy Investigations Clinical (Centor criteria); throat swab/rapid strep test where available if bacterial cause suspected Treatment Objectives Symptom relief; eradicate streptococcal infection to prevent rheumatic fever where confirmed Non-Pharmacological Management • Warm saline gargles • Adequate fluids, soft diet • Voice rest Pharmacological Management • Analgesic/antipyretic PRN • Antibiotics (e.g., penicillin-class, per physician) only if streptococcal infection confirmed/strongly suspected; full course must be completed Referral Criteria Difficulty breathing/swallowing saliva, drooling (children), peritonsillar swelling, symptoms >1 week Prevention & Patient Education Hand hygiene, avoid sharing utensils, complete full antibiotic course when prescribed Acute Bronchitis Case Definition Acute inflammation of the bronchial tree, usually viral Clinical Features Productive cough, mild fever, chest discomfort, wheeze, may follow an upper respiratory infection Investigations Clinical diagnosis; chest X-ray if pneumonia suspected Treatment Objectives Symptom relief; identify and treat bacterial complications Non-Pharmacological Management • Steam inhalation, warm fluids • Avoid smoke/dust/irritant exposure • Rest Pharmacological Management • Antipyretic/analgesic PRN • Bronchodilator if wheeze present (physician-guided) • Antibiotics only if bacterial infection confirmed by physician Referral Criteria Cough >3 weeks, hemoptysis, high fever, breathlessness Prevention & Patient Education Avoid tobacco/smoke exposure, treat URIs early
[Type here] Standards Treatment Guidelines - Dr J L Meena 8 Pulmonary Tuberculosis Case Definition Mycobacterium tuberculosis infection of the lungs; presumptive TB = cough ≥2 weeks with other suggestive features Clinical Features Cough ≥2-3 weeks, evening/low-grade fever, night sweats, weight loss, hemoptysis, chest pain Investigations Sputum smear microscopy, CBNAAT/GeneXpert (drug-resistance screening), chest X-ray - free under NTEP at government facilities Treatment Objectives Bacteriological cure, prevent transmission and drug resistance Non-Pharmacological Management • Nutritional support • Adequate ventilation at home • Adherence counseling and contact tracing Pharmacological Management • DOTS - standardized multi-drug regimen under NTEP (intensive + continuation phase, typically ~6 months for drug-sensitive TB; longer for drug-resistant TB) - free of cost at government centres, dosed and monitored by the treating physician/program Referral Criteria Drug resistance on testing, non-response to first-line therapy, severe illness, comorbid HIV Prevention & Patient Education BCG vaccination in infancy, strict treatment adherence, cough etiquette, contact screening, nutritional support Community-Acquired Pneumonia Case Definition Acute infection of lung parenchyma acquired outside a healthcare setting Clinical Features High fever, cough with purulent sputum, pleuritic chest pain, tachypnea, fatigue; in children - fast breathing, chest indrawing Investigations Clinical exam, pulse oximetry, chest X-ray, CBC where available Treatment Objectives Eradicate infection, prevent respiratory failure and complications Non-Pharmacological Management • Adequate hydration and nutrition • Oxygen supplementation if hypoxic (facility-based) • Chest physiotherapy where indicated Pharmacological Management • Empirical antibiotics per physician assessment and local/national protocol, adjusted to severity and risk factors • Antipyretics/analgesics PRN Referral Criteria (children) Fast breathing, chest indrawing, inability to feed, lethargy, cyanosis - refer/admit immediately Prevention & Patient Education Pneumococcal and influenza vaccination for high-risk groups, prompt treatment of URIs, nutrition in children
[Type here] Standards Treatment Guidelines - Dr J L Meena 9 Section 2: Water- & Food-Borne Illnesses Acute Diarrheal Disease Case Definition Passage of ≥3 loose/watery stools in 24 hours Causes/Risk Factors Viral (most common in children), bacterial, or parasitic contamination of food/water; poor sanitation Clinical Features Loose watery stools, abdominal cramps, nausea, vomiting, variable fever; assess hydration status Investigations Usually clinical; stool exam/culture if severe, bloody, or prolonged >3 days Treatment Objectives Prevent/correct dehydration, maintain nutrition, treat identified bacterial cause Non-Pharmacological Management • Continue breastfeeding/normal feeding - do not withhold food • Bland, easily digestible diet (rice, banana, curd, khichdi) • Hand hygiene for caregivers Pharmacological Management • ORS (WHO low-osmolarity formula) after every loose stool - cornerstone of treatment • Zinc supplementation in children: 20 mg/day for 10-14 days (age ≥6 months); 10 mg/day for infants <6 months, per pediatrician • IV fluids in facility if severe dehydration • Antibiotics only if bacterial dysentery confirmed/strongly suspected by physician - not indicated for most watery diarrhea Referral Criteria Signs of severe dehydration (sunken eyes, lethargy, unable to drink), blood in stool, high fever, diarrhea >3 days, danger signs in infants Prevention & Patient Education Safe drinking water, hand washing, hygienic food storage/preparation, rotavirus vaccination in infancy Cholera Case Definition Acute watery diarrheal illness caused by Vibrio cholerae, can cause rapid severe dehydration Clinical Features Sudden profuse watery ('rice-water') stools, vomiting, rapid dehydration, muscle cramps Investigations Stool culture/rapid test during outbreak confirmation; clinical diagnosis for management Treatment Objectives Rapid rehydration is life-saving; shorten duration of illness and shedding Non-Pharmacological Management • Immediate rehydration - ORS for mild-moderate, IV fluids (e.g., Ringer's Lactate) for severe dehydration at a facility • Isolation and safe disposal of excreta to limit spread Pharmacological Management • Antibiotics (per physician/outbreak protocol) may shorten illness duration in moderate-severe cases • Zinc supplementation in children as per diarrhea protocol Referral Criteria Any suspected cholera case, especially with signs of severe dehydration - immediate facility referral/hospitalization Prevention & Patient Education Safe water and sanitation, oral cholera vaccine in high-risk/outbreak areas, food hygiene, outbreak reporting
[Type here] Standards Treatment Guidelines - Dr J L Meena 10 Typhoid Fever (Enteric Fever) Case Definition Systemic infection caused by Salmonella Typhi/Paratyphi, transmitted via contaminated food/water Clinical Features Stepladder rising fever, malaise, headache, abdominal pain, constipation or diarrhea, relative bradycardia, rose spots (occasional) Investigations Blood culture (gold standard, especially week 1), Widal test (supportive, interpret with caution), CBC Treatment Objectives Eradicate infection, prevent complications (intestinal perforation, relapse) Non-Pharmacological Management • Adequate hydration • Light, easily digestible diet • Rest, monitoring for complications Pharmacological Management • Physician-prescribed antibiotic course based on local sensitivity patterns - full course must be completed even after symptom improvement • Antipyretics for fever Referral Criteria Persistent fever >1 week despite treatment, severe abdominal pain/rigidity (possible perforation), GI bleeding, altered sensorium Prevention & Patient Education Typhoid conjugate vaccine, safe drinking water, food hygiene, hand washing, avoiding street food of doubtful hygiene Viral Hepatitis A / E Case Definition Acute viral hepatitis, fecal-oral transmission, usually self-limiting Clinical Features Jaundice, fatigue, nausea/vomiting, dark urine, pale stools, right upper quadrant discomfort, low-grade fever Investigations LFTs (elevated transaminases, bilirubin), Hepatitis A IgM / Hepatitis E IgM serology Treatment Objectives Supportive care; monitor for fulminant hepatic failure (rare) Non-Pharmacological Management • Rest, adequate hydration • Light, low-fat diet • Avoid alcohol and hepatotoxic drugs Pharmacological Management • No specific antiviral for Hepatitis A/E; avoid unnecessary medication that stresses the liver • Antiemetics/antipyretics used cautiously and only if physician-advised Referral Criteria Signs of hepatic failure - confusion, bleeding tendency, persistent vomiting, worsening jaundice, reduced urine output; pregnant women with suspected Hepatitis E require close monitoring Prevention & Patient Education Hepatitis A vaccination, safe water, food hygiene, avoiding raw shellfish/unhygienic food
[Type here] Standards Treatment Guidelines - Dr J L Meena 11 Soil-Transmitted Helminthiasis Case Definition Intestinal infestation with roundworm, hookworm, whipworm, etc., transmitted via contaminated soil/food Clinical Features Abdominal pain, bloating, poor appetite, perianal itching (worse at night), visible worms in stool, iron-deficiency anemia in chronic infestation Investigations Stool microscopy for ova/parasites where indicated Treatment Objectives Eliminate parasitic burden, correct anemia/nutritional deficits Non-Pharmacological Management • Footwear when outdoors • Washing hands/vegetables/fruits thoroughly • Improved sanitation Pharmacological Management • Deworming tablet (e.g., albendazole/mebendazole class) - single or short course, per pharmacist/physician; delivered through National Deworming Day in schools/anganwadis • Iron/folic acid supplementation if anemic Referral Criteria Severe abdominal pain, signs of intestinal obstruction, worms in vomitus Prevention & Patient Education Biannual deworming for children, hand hygiene, safe water and sanitation Food Poisoning Case Definition Acute gastrointestinal illness from ingestion of contaminated food (toxin or organism- mediated) Clinical Features Sudden-onset vomiting and/or diarrhea, cramps, nausea, typically within hours of ingestion Investigations Usually clinical; stool/food sample testing if outbreak/cluster suspected (report to local health authority) Treatment Objectives Rehydration, symptom control Non-Pharmacological Management • ORS/fluids • Bland diet as tolerated (banana, rice, toast) once vomiting settles • Avoid dairy/oily/spicy food for 1-2 days Pharmacological Management • Antiemetic only if physician-advised • Antibiotics generally not required unless bacterial cause confirmed Referral Criteria Blood in vomit/stool, high fever, dehydration, multiple affected individuals (possible outbreak - report to authorities) Prevention & Patient Education Proper food storage/refrigeration, avoid unhygienic street food, thorough cooking
[Type here] Standards Treatment Guidelines - Dr J L Meena 12 Section 3: Vector-Borne (Mosquito & Insect) Illnesses Malaria Case Definition Fever with confirmed Plasmodium infection by microscopy or RDT Clinical Features Cyclical high fever with chills/rigors, sweating, headache, myalgia, nausea; species-dependent periodicity Investigations Rapid Diagnostic Test (RDT) and/or peripheral blood smear (thick and thin) - mandatory before treatment per NVBDCP protocol Treatment Objectives Parasite clearance, prevention of severe/complicated malaria and transmission Non-Pharmacological Management • Hydration and rest • Antipyretic measures (tepid sponging, fluids) • Vector control at household/community level Pharmacological Management • Species- and severity-specific antimalarial regimen as per National Vector Borne Disease Control Programme (NVBDCP) protocol, prescribed and dosed by a physician • Severe/complicated malaria requires facility-based parenteral therapy and monitoring Referral Criteria Altered sensorium, jaundice, oliguria, respiratory distress, repeated vomiting, signs of severe/complicated malaria - immediate hospitalization Prevention & Patient Education Insecticide-treated bed nets, indoor residual spraying, eliminate breeding sites, prompt fever testing in endemic areas Dengue Fever Case Definition Acute febrile illness caused by dengue virus (Aedes-transmitted); classified as dengue without/with warning signs, or severe dengue Clinical Features Sudden high fever, severe headache, retro-orbital pain, myalgia/arthralgia, rash, mild bleeding manifestations Investigations NS1 antigen (early), IgM/IgG serology, CBC with platelet count and hematocrit monitoring Treatment Objectives Supportive management, early detection of plasma leakage/warning signs to prevent severe dengue Non-Pharmacological Management • Adequate oral fluid intake • Rest • Regular monitoring of platelet count/hematocrit and vital signs Pharmacological Management • Paracetamol only for fever/pain - NSAIDs and aspirin strictly avoided (bleeding risk) • IV fluids per physician if warning signs/plasma leakage present Referral Criteria (warning signs) Severe abdominal pain, persistent vomiting, bleeding gums/nose, hematemesis/melena, restlessness or lethargy, cold clammy extremities - emergency referral Prevention & Patient Education Eliminate stagnant water/breeding sites, repellents, mosquito nets/screens, full-sleeve clothing
[Type here] Standards Treatment Guidelines - Dr J L Meena 13 Chikungunya Case Definition Acute febrile illness with arthralgia caused by chikungunya virus (Aedes-transmitted) Clinical Features High fever, severe polyarthralgia with swelling, maculopapular rash, headache, myalgia Investigations IgM serology; CBC/other tests to rule out dengue/malaria co-infection Treatment Objectives Symptomatic relief; management of chronic arthralgia Non-Pharmacological Management • Rest, adequate fluids • Physiotherapy for persistent joint symptoms • Avoid NSAIDs until dengue excluded Pharmacological Management • Paracetamol for fever/pain acutely • Physician-guided analgesics/physiotherapy for chronic arthralgia (may persist weeks- months) Referral Criteria Signs of neurological involvement, severe unrelenting joint symptoms, atypical/complicated presentation Prevention & Patient Education Same vector control measures as dengue Lymphatic Filariasis Case Definition Infection with filarial parasites transmitted by mosquito vectors, causing lymphatic damage Clinical Features Often asymptomatic (microfilaremia); acute filarial fever with lymphadenitis; chronic limb/genital lymphedema (elephantiasis) Investigations Night blood smear for microfilariae, antigen testing where available Treatment Objectives Reduce microfilarial load, prevent transmission, manage lymphedema Non-Pharmacological Management • Limb hygiene and elevation, exercise for lymphedema management • Vector control Pharmacological Management • Antifilarial combination therapy delivered through Mass Drug Administration (MDA) in endemic districts, per National Filariasis Elimination Programme Referral Criteria Progressive lymphedema, recurrent acute attacks, hydrocele requiring surgical evaluation Prevention & Patient Education Participation in MDA rounds, mosquito control, limb care education for affected individuals Japanese Encephalitis Case Definition Acute encephalitis syndrome caused by JE virus, mosquito-borne, endemic in specific regions of India Clinical Features High fever, headache, vomiting, neck stiffness, altered consciousness, seizures - predominantly in children Investigations CSF analysis, JE-specific IgM ELISA (serum/CSF), neuroimaging where available
[Type here] Standards Treatment Guidelines - Dr J L Meena 14 Treatment Objectives Supportive critical care; no specific antiviral exists Non-Pharmacological Management • Facility-based supportive care - airway management, fluid balance, seizure precautions Pharmacological Management • Anticonvulsants for seizure control (physician-directed) • Supportive management of raised intracranial pressure/complications in hospital Referral Criteria Any suspected case is a medical emergency - immediate hospital referral Prevention & Patient Education JE vaccination in childhood immunization schedule (endemic states), vector control, pig- rearing/breeding site management in endemic areas
[Type here] Standards Treatment Guidelines - Dr J L Meena 15 Section 4: Skin, Eye & Common Infections Dermatophytosis (Ringworm/Tinea) Case Definition Superficial fungal infection of skin, often recurrent in humid climates Clinical Features Itchy, annular erythematous rash with central clearing; commonly in groin, axillae, feet Investigations Clinical diagnosis; KOH mount if diagnosis uncertain or recurrent Treatment Objectives Mycological cure, prevent recurrence and spread Non-Pharmacological Management • Keep affected area dry • Loose cotton clothing • Avoid sharing towels/clothing/combs Pharmacological Management • Topical antifungal (e.g., clotrimazole/terbinafine class) applied for 2-4 weeks, continuing beyond visible clearance • Oral antifungal (physician-prescribed) for extensive/recurrent/nail involvement Referral Criteria No improvement despite adequate topical therapy, extensive/recurrent disease, scalp or nail involvement Prevention & Patient Education Hygiene, avoid sharing personal items, treat close contacts if infected Scabies Case Definition Infestation with Sarcoptes scabiei mite, highly contagious via close contact Clinical Features Intense pruritus (worse at night), burrows/papules typically in finger webs, wrists, waistline Investigations Clinical diagnosis; microscopy of skin scraping where needed Treatment Objectives Eradicate mite infestation, treat secondary infection, prevent household spread Non-Pharmacological Management • Wash bedding/clothing in hot water • Treat all household/close contacts simultaneously regardless of symptoms Pharmacological Management • Topical scabicide (physician-prescribed) applied to entire body as directed • Antihistamine for itch relief if needed, physician-guided Referral Criteria Signs of secondary bacterial infection (spreading redness, pus, fever), crusted/severe scabies Prevention & Patient Education Avoid close contact with untreated individuals, simultaneous treatment of contacts, personal hygiene Urinary Tract Infection Case Definition Bacterial infection of the urinary tract (lower or upper) Clinical Features Dysuria, urinary frequency/urgency, suprapubic pain, cloudy/malodorous urine; fever and flank pain suggest upper tract involvement
[Type here] Standards Treatment Guidelines - Dr J L Meena 16 Investigations Urinalysis, urine culture and sensitivity (especially recurrent/complicated cases) Treatment Objectives Eradicate infection, prevent recurrence and ascending/renal involvement Non-Pharmacological Management • Increased oral fluid intake • Good perineal hygiene • Avoid holding urine for prolonged periods Pharmacological Management • Physician-prescribed antibiotic course guided by local sensitivity/culture results - full course must be completed • Analgesic/antipyretic PRN Referral Criteria Fever with UTI symptoms, flank pain (pyelonephritis), recurrent UTIs, pregnancy, male patients (evaluate for underlying cause) Prevention & Patient Education Hydration, hygiene, voiding after intercourse, prompt treatment of symptomatic episodes Acute Conjunctivitis Case Definition Inflammation of the conjunctiva, commonly viral or bacterial, highly contagious Clinical Features Redness, itching, watery or purulent discharge, often starting unilaterally and spreading Investigations Clinical diagnosis; swab/culture reserved for severe/atypical/neonatal cases Treatment Objectives Symptom relief, prevent transmission, treat bacterial cause where present Non-Pharmacological Management • Cold compresses • Strict hand hygiene • Avoid sharing towels/pillows, avoid touching/rubbing eyes Pharmacological Management • Topical antibiotic eye drops only if bacterial cause confirmed/suspected by physician • Lubricating drops for symptomatic relief Referral Criteria Severe pain, photophobia, blurred vision, no improvement within a week, neonatal conjunctivitis Prevention & Patient Education Hand hygiene, avoid sharing personal items during outbreaks, school/workplace exclusion until resolving per local guidance Varicella (Chickenpox) Case Definition Acute vesicular exanthem caused by primary varicella-zoster virus infection Clinical Features Pruritic vesicular rash appearing in crops, mild fever, malaise; typically more severe in adults, pregnant women, immunocompromised Investigations Clinical diagnosis; testing reserved for atypical/severe/high-risk cases Treatment Objectives Symptom relief, prevent secondary bacterial infection and complications Non-Pharmacological Management • Keep nails short to reduce scratching/scarring • Calamine lotion for itching
[Type here] Standards Treatment Guidelines - Dr J L Meena 17 • Isolation until all lesions crust over Pharmacological Management • Paracetamol for fever - avoid aspirin (Reye's syndrome risk in children) • Antiviral (physician-prescribed) for adults, immunocompromised, or severe cases, ideally started early Referral Criteria High fever, breathing difficulty, signs of secondary skin infection, disease in newborns/pregnant women/immunocompromised individuals Prevention & Patient Education Varicella vaccination, isolation of active cases, avoiding contact with susceptible high-risk individuals
[Type here] Standards Treatment Guidelines - Dr J L Meena 18 Section 5: Chronic & Lifestyle Conditions Type 2 Diabetes Mellitus Case Definition Chronic metabolic disorder characterized by hyperglycemia due to insulin resistance/deficiency Clinical Features Polyuria, polydipsia, unexplained fatigue, blurred vision, slow-healing wounds, paresthesia Investigations Fasting/postprandial blood glucose, HbA1c, periodic renal function, lipid profile, fundus and foot examination Treatment Objectives Achieve glycemic targets, prevent micro/macrovascular complications Non-Pharmacological Management • Medical nutrition therapy (complex carbohydrates, portion control) • Regular physical activity (150 min/week moderate exercise) • Weight management, smoking/alcohol cessation counseling Pharmacological Management • Oral hypoglycemics or insulin as prescribed by physician, individualized to patient profile • Regular self-monitoring of blood glucose as advised Referral Criteria Uncontrolled glycemia despite therapy, hypoglycemic/hyperglycemic emergencies, diabetic foot, nephropathy/retinopathy findings Prevention & Patient Education Routine screening after age 30-40 or earlier with risk factors, healthy lifestyle, foot care education, regular follow-up Hypertension Case Definition Persistently elevated blood pressure (≥140/90 mmHg on repeated measurement, per standard criteria) Clinical Features Often asymptomatic; occasional headache, dizziness, epistaxis Investigations Serial BP measurement, renal function, lipid profile, ECG, fundus examination as indicated Treatment Objectives Achieve target BP control, reduce cardiovascular/renal risk Non-Pharmacological Management • Dietary salt restriction • Regular aerobic exercise • Weight management, limit alcohol, avoid tobacco • Stress management, home BP monitoring Pharmacological Management • Antihypertensive medication as prescribed by physician, individualized and titrated to target Referral Criteria Severely elevated BP with symptoms (headache, chest pain, vision changes, confusion) - hypertensive emergency; resistant hypertension Prevention & Patient Education Regular BP screening from age 40 (earlier with risk factors/family history), lifestyle modification, medication adherence
[Type here] Standards Treatment Guidelines - Dr J L Meena 19 Bronchial Asthma Case Definition Chronic inflammatory airway disease with variable, reversible airflow obstruction Clinical Features Recurrent wheezing, breathlessness, chest tightness, cough (often nocturnal or exercise/allergen-triggered) Investigations Clinical diagnosis; peak flow/spirometry where available; trigger identification Treatment Objectives Symptom control, prevent exacerbations, maintain normal activity Non-Pharmacological Management • Trigger avoidance (dust, smoke, pollen, cold air) • Written asthma action plan • Breathing exercises as adjunct Pharmacological Management • Reliever inhaler for acute symptoms and controller inhaler for long-term control, as prescribed and stepped up/down by physician per severity Referral Criteria Reliever not relieving symptoms, inability to speak full sentences, cyanosis, rapidly worsening breathlessness - emergency Prevention & Patient Education Trigger avoidance, annual influenza vaccination, correct inhaler technique training, adherence to controller therapy Iron-Deficiency Anemia Case Definition Anemia resulting from inadequate iron for hemoglobin synthesis Clinical Features Fatigue, pallor, exertional breathlessness, dizziness, brittle nails, pica Investigations CBC, peripheral smear, serum ferritin where available; evaluate underlying cause (dietary, worm infestation, menorrhagia, GI blood loss) Treatment Objectives Correct anemia, replenish iron stores, treat underlying cause Non-Pharmacological Management • Iron-rich diet (leafy greens, jaggery, legumes, dates) • Vitamin C-rich foods alongside meals to improve iron absorption Pharmacological Management • Oral iron-folic acid supplementation as prescribed, duration guided by response and repeat hemoglobin • Treat underlying cause (deworming, menorrhagia management, etc.) Referral Criteria Severe anemia, breathlessness at rest, suspected GI bleeding, non-response to oral iron Prevention & Patient Education Balanced diet, routine deworming, national IFA supplementation programs for at-risk groups (pregnant women, adolescent girls) Hypothyroidism Case Definition Clinical syndrome resulting from deficient thyroid hormone production Clinical Features Fatigue, weight gain, cold intolerance, dry skin, hair thinning, constipation, low mood, bradycardia Investigations TSH, free T4; periodic monitoring after treatment initiation
[Type here] Standards Treatment Guidelines - Dr J L Meena 20 Treatment Objectives Restore euthyroid state, symptom resolution Non-Pharmacological Management • Regular follow-up and monitoring • Balanced diet Pharmacological Management • Thyroid hormone replacement as prescribed by physician, dose titrated based on periodic TSH testing Referral Criteria Severe symptoms (myxedema, bradycardia, altered consciousness), pregnancy, poor response to standard therapy Prevention & Patient Education Medication adherence, regular follow-up testing, awareness of symptom recurrence Gastro-Esophageal Reflux Disease (GERD)/Gastritis Case Definition Reflux of gastric contents causing troublesome symptoms and/or mucosal inflammation Clinical Features Retrosternal/epigastric burning, bloating, acidity, occasional nausea, worse after spicy/oily food or lying down Investigations Clinical diagnosis; H. pylori testing and/or endoscopy for recurrent/alarm symptoms Treatment Objectives Symptom relief, mucosal healing, prevent complications Non-Pharmacological Management • Smaller, frequent meals • Avoid spicy/oily/late-night meals • Avoid lying down immediately after eating • Weight management, reduce caffeine/alcohol Pharmacological Management • Antacids for occasional symptoms • Physician-prescribed acid-suppressive therapy (PPI/H2 blocker class) for persistent symptoms • H. pylori eradication therapy if confirmed Referral Criteria Dysphagia, unintentional weight loss, hematemesis, melena, symptoms persisting >2 weeks despite treatment Prevention & Patient Education Dietary and lifestyle modification, avoid NSAID overuse, timely medical review for persistent symptoms Migraine Case Definition Recurrent primary headache disorder, often unilateral and throbbing, with associated symptoms Clinical Features Moderate-severe throbbing headache, nausea, photophobia/phonophobia, occasional visual aura Investigations Clinical diagnosis; neuroimaging only for atypical presentation or red-flag features Treatment Objectives Acute symptom relief, reduction in attack frequency/severity
[Type here] Standards Treatment Guidelines - Dr J L Meena 21 Non-Pharmacological Management • Rest in a dark, quiet room • Cold compress • Trigger identification and avoidance (certain foods, stress, poor sleep, skipped meals) Pharmacological Management • Physician-guided acute analgesic therapy for attacks • Preventive medication considered if frequent (≥4/month) or severely disabling, per physician Referral Criteria Sudden severe ('thunderclap') headache, headache with fever/neck stiffness, new neurological deficit, headache after head trauma Prevention & Patient Education Trigger diary, regular sleep/meal schedule, stress management Hemorrhoids (Piles) Case Definition Symptomatic swelling/prolapse of anal vascular cushions Clinical Features Painless or painful bleeding per rectum, perianal itching/discomfort, palpable lump, worse with straining Investigations Clinical/proctoscopic examination; colonoscopy if alarm features or age >45-50 with rectal bleeding Treatment Objectives Symptom relief, prevent progression/complications Non-Pharmacological Management • High-fiber diet, adequate fluid intake • Warm sitz baths • Avoid straining and prolonged sitting/toileting Pharmacological Management • Topical preparations for symptomatic relief, physician/pharmacist-guided • Procedural/surgical referral for persistent grade III-IV disease Referral Criteria Heavy or persistent bleeding, severe pain, irreducible prolapse, anemia from chronic blood loss, alarm features suggesting other pathology Prevention & Patient Education Fiber-rich diet, adequate hydration, avoid prolonged straining Nephrolithiasis (Kidney Stones) Case Definition Formation of calculi within the urinary tract Clinical Features Sudden severe colicky flank pain radiating to groin, hematuria, nausea/vomiting, dysuria Investigations Urinalysis, ultrasound KUB, non-contrast CT for definitive characterization where available Treatment Objectives Pain relief, stone clearance/removal, prevention of recurrence Non-Pharmacological Management • Increased fluid intake • Dietary modification based on stone composition (reduced salt, moderated animal protein/oxalate as advised) Pharmacological Management • Analgesics for renal colic, physician-guided
[Type here] Standards Treatment Guidelines - Dr J L Meena 22 • Medical expulsive therapy for select small stones per physician • Procedural intervention for larger/obstructing stones Referral Criteria Severe unrelenting pain, fever with stone symptoms (obstructive infection - urological emergency), anuria, solitary kidney with obstruction Prevention & Patient Education Adequate hydration, dietary counseling based on stone type, regular follow-up if recurrent stone former
[Type here] Standards Treatment Guidelines - Dr J L Meena 23 Section 6: Emergencies Requiring Immediate Referral Facility-level stabilization and immediate transfer - do not delay for full work-up Condition Key Signs Immediate Action Heat Stroke High body temperature, hot dry skin, confusion, rapid pulse, no sweating Move to shade/cool area, remove excess clothing, cool with water/fan, transport to hospital immediately Snake Bite Bite marks, local swelling, pain, possible bleeding/breathing difficulty Keep patient calm and still, immobilize the limb, do NOT cut/suck the wound or apply a tourniquet, transport immediately for antivenom Anaphylaxis Facial/throat swelling, difficulty breathing, widespread rash, dizziness after allergen exposure Administer epinephrine auto-injector if available/prescribed, transport to hospital immediately Suspected Rabies Exposure Bite/scratch from dog, cat, or other mammal, especially unvaccinated/stray Wash wound thoroughly with soap and water for 15 minutes, seek immediate post-exposure prophylaxis Acute Coronary Syndrome Crushing chest pain, radiation to arm/jaw, sweating, breathlessness Call emergency services immediately, keep patient calm and seated, transport without delay Severe Burns Deep or extensive burns, blistering Cool with clean running water (not ice), cover loosely with clean cloth, transport for emergency care - do not apply toothpaste/oil
[Type here] Standards Treatment Guidelines - Dr J L Meena 24 Quick First-Aid & Self-Care Reference Situation Immediate Action Dehydration (any cause) ORS after every loose stool/episode; zinc per protocol in children; frequent small sips High fever in a child Antipyretic per weight/age (confirm dose with physician/pharmacist), tepid sponging, light clothing, fluids Suspected dengue/malaria fever Avoid aspirin/NSAIDs - paracetamol only; seek prompt testing Any fever lasting more than 3 days Refer for medical evaluation - do not self-medicate with antibiotics Minor cuts/wounds Clean with water, apply antiseptic, cover; monitor for signs of infection Any animal bite Wash thoroughly with soap/water for 15 minutes, refer for rabies post- exposure assessment
[Type here] Standards Treatment Guidelines - Dr J L Meena 25 References • National Health Mission (NHM), Ministry of Health and Family Welfare, Government of India - Standard Treatment Guidelines and program documents • National Health Systems Resource Centre (NHSRC) - Standard Treatment Guidelines, various state adaptations • National Tuberculosis Elimination Programme (NTEP), Ministry of Health and Family Welfare - Technical and Operational Guidelines for TB Control • National Vector Borne Disease Control Programme (NVBDCP) - Guidelines for Diagnosis and Treatment of Malaria, Dengue, Chikungunya, and Lymphatic Filariasis • World Health Organization (WHO) - Guidelines for the Treatment of Malaria; WHO/UNICEF Joint Statement on Clinical Management of Acute Diarrhoea (ORS and zinc) • World Health Organization (WHO) - Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses • Indian Council of Medical Research (ICMR) - Clinical guidance documents and treatment advisories • Indian Academy of Pediatrics (IAP) - Standard Treatment Guidelines and Immunization Timetable • Integrated Disease Surveillance Programme (IDSP), National Centre for Disease Control (NCDC) - Outbreak and disease management guidance • Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of India This document synthesizes and structurally follows the above categories of publicly available national/international guidance for educational purposes. It is not an official reproduction of any single source and should not be cited as one.
[Type here] Standards Treatment Guidelines - Dr J L Meena 26 Abbreviations Abbreviation Full Form STG Standard Treatment Guidelines NHM National Health Mission NHSRC National Health Systems Resource Centre NTEP National Tuberculosis Elimination Programme NVBDCP National Vector Borne Disease Control Programme DOTS Directly Observed Treatment, Short-course WHO World Health Organization ICMR Indian Council of Medical Research IAP Indian Academy of Pediatrics IDSP Integrated Disease Surveillance Programme NCDC National Centre for Disease Control PHC / CHC Primary Health Centre / Community Health Centre ORS Oral Rehydration Solution IV Intravenous PO Per Oral (by mouth) PRN Pro re nata (as needed) RDT Rapid Diagnostic Test CBNAAT Cartridge-Based Nucleic Acid Amplification Test RT-PCR Reverse Transcription Polymerase Chain Reaction RAT Rapid Antigen Test SpO2 Peripheral Oxygen Saturation CBC Complete Blood Count LFT Liver Function Test HbA1c Glycated Hemoglobin TSH Thyroid-Stimulating Hormone PPI Proton Pump Inhibitor NSAID Non-Steroidal Anti-Inflammatory Drug GERD Gastro-Esophageal Reflux Disease UTI Urinary Tract Infection
[Type here] Standards Treatment Guidelines - Dr J L Meena 27 Abbreviation Full Form JE Japanese Encephalitis ILI Influenza-Like Illness MDA Mass Drug Administration KOH Potassium Hydroxide (microscopy mount) IgM / IgG Immunoglobulin M / Immunoglobulin G ECG Electrocardiogram KUB Kidney, Ureter, Bladder (imaging)
[Type here] Standards Treatment Guidelines - Dr J L Meena 28 Important Notes • This document follows the structural format of India's Standard Treatment Guidelines (STG) - Case Definition, Clinical Features, Investigations, Treatment Objectives, Non-Pharmacological & Pharmacological Management, Referral Criteria, and Prevention - as used by NHM/NHSRC and state health departments. • Specific antibiotic, antimalarial, and antiviral dosing has intentionally been kept at protocol/class level rather than exact mg/kg figures, since correct dosing depends on the patient's age, weight, renal/hepatic function, and current local resistance patterns - this must be individualized by the treating physician. • Never self-prescribe antibiotics or antimalarials - misuse drives antimicrobial resistance, a serious and growing public health concern in India. • ORS + zinc remains the single most life-saving home treatment for diarrhea in children under 5. • Government health infrastructure - Sub-Centres, PHCs, CHCs, District Hospitals, and Jan Aushadhi Kendras - provide free/low-cost consultations, diagnostics, and generic medicines under National Health Mission programs (NTEP for TB, NVBDCP for vector-borne disease, etc.). • Emergency number in India: 108 (ambulance, most states) or 112 (national emergency number). This chart is a general educational reference modeled on standard treatment guideline structure. It is not an official government document. Diagnosis, drug selection, and dosing must always be confirmed by a licensed medical practitioner. ॐ जय माता द( ॐ
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