WHO updates Essential Medicines List, recommendations for antibiotics

The World Health Organization (WHO) has updated its Essential Medicines List for 2017 to include new recommendations on which antibiotics to use for common infections and which to use for the most serious conditions. New drugs for HIV, hepatitis C, tuberculosis, and leukemia have also been added to the list.

The WHO Model List of Essential Medicines was launched in 1977 and is updated and revised every 2 years by the WHO Expert Committee on the Selection and Use of Essential Medicines. The 2017 updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products. A total of 433 drugs are now deemed essential for addressing the most important public health needs.

“Safe and effective medicines are an essential part of any health system,” stated Marie-Paule Kieny, MD, WHO Assistant Director-General for Health Systems and Innovation. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress toward universal health coverage.”

WHO experts have grouped antibiotics into 3 categories – ACCESS, WATCH, and RESERVE – with recommendations on when each category should be used. Antibiotics in the ACCESS group should be available at all times as treatment options for a wide range of common infections. The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. The RESERVE group 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.

The updated EML also includes:

Two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease.
Sofosbuvir + velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C).
Dolutegravir for treatment of patients with HIV infection, in response to the most recent evidence showing the medicine’s safety, efficacy, and high barrier to resistance.
Pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection.
Delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB.
Child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol, and pyrazinamide for treating pediatric tuberculosis.
Fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care.

“The rise in antibiotic resistance stems from how we are using – and misusing – these medicines,” said Dr Suzanne Hill, PhD, WHO Director of Essential Medicines and Health Products. “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 doesn’t get worse.”