WHO revises antibiotics protocol

The WHO has now recommended that antibiotics in the ‘access’ group, including amoxicillin, be available at all times as treatment for a wide range of common infections.

WHO has put commonly used antibiotics under the ‘access’ category; the second line of antibiotics, slightly more potent, have been categorised under ‘watch’ and potent drugs to be used only as a “last resort” fall under the ‘reserve’ category. Photo: Special Arrangement

In an effort to curb antibiotic resistance, the World Health Organization (WHO) has divided the drugs into three categories — access, watch and reserve — specifying which are to be used for common ailments and which are to be kept for complicated diseases.

Commonly used antibiotics will be under the ‘access’ category; the second line of antibiotics, slightly more potent, have been categorised under “watch” and potent drugs to be used only as a “last resort” fall under the ‘reserve’ category. This is the biggest revision of the antibiotics section in the 40-year history of the essential medicines list (EML).

“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 that 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 WHO has now recommended that antibiotics in the ‘access’ group be available at all times as treatment for a wide range of common infections. This includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The ‘watch’ group covers antibiotics that are recommended as first or second choice treatment for a small number of infections.

Ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (like bacterial sinusitis and bacterial bronchitis), falls under this category. The WHO has recommended that prescription of these drugs should be dramatically reduced to avoid further development of resistance.

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.

The new categorisation will further guide countries in ensuring access to appropriate antibacterial agents and support antimicrobial stewardship effort, said Dr. Sumanth Gandra from the Center for Disease Dynamics, Economics and Policy (CDDEP).

Model list

“The Model List of Essential Medicines necessarily has a sharp focus on preserving antimicrobials. This list serves as a guide for the medicine supply system and is responsible for promoting health equity,” said Dr. Gandra, who was a part of the WHO expert committee that helped shape the revised list and recommended these three categories.