WHO Updates Essential Medicines List

The agency's experts have grouped antibiotics into three categories – ACCESS, WATCH, and RESERVE – with recommendations on when each category should be used. This change aims to ensure that antibiotics are available when needed, reduce the development of drug-resistant bacteria, and preserve the effectiveness of "last resort" antibiotics.

The World Health Organization has updated its Essential Medicines List with new advice on use of antibiotics and also added medicines for hepatitis C, HIV, tuberculosis, and cancer. The new advice addresses which antibiotics to use for common infections and which to preserve for the most serious circumstances, according to the agency. 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.

This list is used by many countries to increase access to medicines and guide decisions about which products to make available for their populations. "Safe and effective medicines are an essential part of any health system," explained Dr. Marie-Paule Kieny, WHO's 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 towards universal health coverage."

The agency's experts have grouped antibiotics into three categories – ACCESS, WATCH, and RESERVE – with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections, but if shown to be useful, they could be broadened in future versions of the list to apply to drugs to treat other infections. WHO said 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 drug-resistant bacteria, and preserve the effectiveness of 'last resort' antibiotics that are needed when all others fail." This supports WHO's global action plan on antimicrobial resistance.

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. The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections and should be dramatically reduced to avoid further development of resistance. 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, such as for life-threatening infections due to multidrug-resistant bacteria.

"The rise in antibiotic resistance stems from how we are using – and misusing – these medicines," said Dr. Suzanne Hill, 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."

The updated list's new drugs include 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.

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