WHO updates Model List of Essential Medicines

The World Health Organization (WHO) has updated its Model List of Essential Medicines  (EML) earlier this year (in March 2017).

Background information:

The core list presents a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe and cost–effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment.

The complementary list presents essential medicines for priority diseases, for which specialized diagnostic or monitoring facilities, and/or specialist medical care, and/or specialist training are needed. In case of doubt medicines may also be listed as complementary on the basis of consistent higher costs or less attractive cost-effectiveness
in a variety of settings.

The square box symbol () is primarily intended to indicate similar clinical performance within a pharmacological class.

Key Messages:

This is the 20th edition of the WHO Model List of Essential Medicines.

There are separate lists of Essential Medicines for adults and children.

For the first time, WHO 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. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.

WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections.

2017-06-07 21_09_57-ACCESS group antibiotics adult

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 as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

2017-06-07 21_10_59-WATCH group antibiotics adults

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.

2017-06-07 21_11_51-RESERVE group antibiotics adults

WHO experts have added 10 antibiotics to the 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 paediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:

  • two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia 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 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 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.

Useful Links:

Link to the WHO news release (6 June 2017):

http://who.int/mediacentre/news/releases/2017/essential-medicines-list/en/

Link to the updated WHO List of Essential Medicines for adults (English)[PDF]:

http://who.int/medicines/publications/essentialmedicines/20th_EML2017.pdf

Link to the updated WHO List of Essential Medicines for children (English)[PDF]:

http://who.int/medicines/publications/essentialmedicines/6th_EMLc2017.pdf