WHO Revises and Updates Essential Medicines List

The World Health Organization (WHO, Geneva, Switzerland) Essential Medicines List (EML) for 2017 includes the biggest revision of the antibiotics section ever seen and new additions for hepatitis C virus (HCV), HIV, tuberculosis, and leukemia.

The updated EML 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 revised antibiotics section now groups antibiotics into three categories:

ACCESS – antibiotics that should 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.

WATCH - antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, use of ciprofloxacin, used to treat cystitis (a urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

RESERVE - 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 life-threatening infections due to multidrug-resistant bacteria.

The new categories are intended to ensure antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections, so that they enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of "last resort" antibiotics that are needed when all others fail. The changes support the WHO Global action plan against antimicrobial resistance development in 21 of the most common general infections. If shown to be useful, the list could be broadened in future versions of the EML.

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

The updated EML also includes several new drugs, such as two oral cancer medicines (dasatinib and nilotinib); sofosbuvir + velpatasvir, the first combination therapy that treats all six types of HCV; dolutegravir, 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; delamanid, a new pediatric formulations for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB); and several other drugs.

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