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Volume:7, Number:49
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Essential Medicines Revised

WHO has revised its essential medicines list with new advice on use of antibiotics and adding 30 medicines for adults and 25 for children

The World Health Organization (WHO) has updated essential medicines’ list with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, TB and cancer. New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to WHO’s Model List of Essential Medicines for 2017.

Other additions include medicines for HIV, hepatitis C, tuberculosis and leukemia— a form of blood cancer. The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for nine already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The list is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations. As world faces eminent threat of losing efficacy of antibiotics, largely owing to misuse of these lifesaving medicines, WHO has revised the section in the EML after 40 years. Experts have grouped antibiotics into three broad categories—accessible, use under watch, and in use for emergencies. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections, say WHO experts. The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drugresistant bacteria, and preserve the effectiveness of “last resort” antibiotics that are needed when all others fail.

While WHO has a Global Action Plan on antimicrobial resistance that aims to fight the development of drug resistance by ensuring the best use of antibiotics, India also released a National Action Plan against antimicrobial resistance earlier this year. WHO recommends that antibiotics in the access group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely used antibiotic to treat infections such as pneumonia. The watch group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance. The third group, reserve, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria. Ten antibiotics have been added to the WHO list for adults and 12 for children.

The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new pediatric formulations of medicines for tuberculosis, and pain relievers. The medicines are two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment. The WHO Model List of Essential Medicines was launched in 1977, coinciding with the endorsement by governments at the World Health Assembly of “Health for all” as the guiding principle for WHO and countries’ health policies. Many countries have adopted the concept of essential medicines and have developed lists of their own, using the EML as a guide. The EML is updated and revised every two years by the WHO expert committee on the selection and use of essential medicines.

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