WHO updates list of essential drugs

The World Health Organisation has released a list of medication which should be available to everyone, anywhere.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for nine already listed drugs, bringing the total to 433 drugs deemed essential for addressing the most important public health needs.

These medicines are chosen according to evidence of safety, efficacy, and public health relevance, said Dr Marie-Paule Kieny, WHO assistant director-general for health systems and innovation adding that essential medicines should be available in health systems everywhere, at all times.

The latest version of the essential medicines list includes the first combination therapy to treat all six types of hepatitis C. However, no second line treatment for breast cancer has been added this year.

The updated list includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, 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 child-friendly formulations of medicines for tuberculosis, leukaemia and pain relievers have also been added.

“Safe and effective medicines are an essential part of any health system,” said Dr Kieny. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

The latest update to the WHO’s Essential Medicines List contains the biggest change to the antibiotics section in the list’s 40-year history.

By grouping antibiotics into three categories — access, watch, and reserve — for guidance in deciding when certain antibiotics should be used, the international health organisation has now separated the drugs into categories ranging from those that treat common infections to those that can only be used as a last resort.

IMPROVING OUTCOMES

Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections.

WHO recommends that antibiotics in the “access” group are drugs that have lower potential for resistance and should be available at all times for treatment for a wide range of common infections. This category includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The “watch” antibiotics are recommended as first- or second-choice treatments that should be used only for a small number of infections.

This category includes drugs like ciprofloxacin which is used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis).

Finally, the third group, “reserve” contains last-resort drugs, such as colistin and some new-generation cephalosporins that should be used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.

WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

“The rise in antibiotic resistance stems from how we are using – and misusing – these medicines,” said Dr Suzanne Hill, the director of essential medicines and health products.

According to WHO, this change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections.

“The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance does not get worse,” added Dr Hill.

It is also aimed at improving outcomes, reducing emergence of drug-resistant bacteria, and making sure “last resort” antibiotics work when all others fail.

Once every two years, the World Health Organisation releases a list of medications it thinks should be available, if needed, to all the people on earth.

The 2017 list takes into account a review of all 39 essential antibiotics on the list against 21 common infections. 

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Some essential drugs

1.Two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment

2.Sofosbuvir and velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C).

3.Dolutegravir for treatment of HIV in response to the most recent evidence showing the drug’s safety, efficacy, and high barrier to resistance

4.Pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection

5.Delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB

6.Child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol and pyrazinamide for treating paediatric tuberculosis; and fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care