WHO issues new guidelines on antibiotic use

Rafat Salami

The World Health Organization has published a new classification of antibiotics aiming to fight drug resistance, with penicillin-type drugs recommended as the first line of defense and others only for use when absolutely necessary.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs.

It grouped antibiotics into three categories,  “ACCESS, WATCH and RESERVE – with recommendations on when each category should be used”

In the biggest revision of the antibiotics section in the Essential MedicineList’s 40-year history, WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections, while the WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections.

The third group, RESERVE, includes antibiotics 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.

Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation said “safe and effective medicines are an essential part of any health system,” adding that ensuring that “all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

The WHO classification takes into account the use of antibiotics for animal health use, and was developed together with the U.N. Food and Agriculture Organisation and the World Organisation for Animal Health.

“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.”

Other additions

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.