“Inappropriate use of antibiotics drives its resistance”

The World Health Organization’s Expert Committee has recently recommended the addition of new medicines in its 20^th Model List of Essential Medicines besides listing out separate recommendations for antibiotics. In this context, the BioVoice News spoke to one of the expert committee member, Dr Sumanth Gandra who is also a Resident Scholar and Fellow, Center for Disease Dynamics, Economics & Policy (CDDEP). The interaction focused on the various aspects related to this updation among other things. Read on: 

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Why does the WHO release Essential Medicines Lists for adults and children? How much useful are the updations of these lists at regular intervals? 

Essential medicines are the medicines that satisfy the priority healthcare needs of the population. The list is developed to guide member states to develop their individual national or institutional essential medicines list.  The medicines in the list are intended to be available within the context of individual members health systems in sufficient quantity and with assured quality. In addition to public health relevance, essential medicines are selected based on the evidence on effectiveness, safety and comparative cost effectiveness of the drug.

In the updated 2017 EML, 30 new medicines were added to adult list and 25 to children list. Some of the major highlights include comprehensive review of anti-bacterial agents; addition of delamanid for treatment of multi-drug resistant TB; pediatric fixed dose combinations for treatment of TB and new drugs for HIV.

Inappropriate and overuse of antibiotics is one of the major drivers of antibiotic resistance. The comprehensive review of anti-bacterial agents in this updated list, guides member states to take steps to reduce the inappropriate use of antibiotics. Addition of new pediatric friendly formulations and a new drug (delamanid) for treatment of TB is very important in the control and management of TB, especially for children.

“It is estimated that about 10 million deaths along with a reduction of 2% to 3.5% in Gross Domestic Product (GDP) would result in 2050 due to antimicrobial resistance if we do not take any steps”

Any specific reasons for doing that after two years and not on annual basis?

I assume the reason for updating every two years instead of yearly, is mainly logistics.

Why do the antibacterials feature prominently in this year’s list? Is it usual or there indeed was a need to do so owing to certain factors? If yes then what are those? 

Antibiotic resistance is recognized as a major public health threat. It is estimated that about 10 million deaths along with a reduction of 2% to 3.5% in Gross Domestic Product (GDP) would result in 2050 due to antimicrobial resistance if we do not take any steps. WHO and United Nations recognize this as a major crisis and are making efforts to urgently address the issue of antibiotic resistance. As part of the WHO’s Global Action Plan on antimicrobial resistance, optimizing the use of antibiotics is one of the five key objectives and thus anti-bacterials (antibiotics) are featured prominently in this list.

“In India, resistance to last resort drug “colistin” is increasing in a bacterium called K. pneumonia which causes serious infections among hospitalized patients”

What was the reason for the creation of 3 categories in case of antimicrobials on the latest list?

Antibiotics are life saving medicines and access to these drugs is vital in preventing death from serious bacterial infections. However, antibiotics if taken inappropriately, would lead to antibiotic resistance. Thus, the optimization of antibiotic includes balancing the issue of access to these life saving drugs and at the same time limiting unnecessary use.

The categorization was done not only to improve access, but at the same time to reduce the potential for development of antibiotic resistance, and preserve the effectiveness of ‘last resort’ antibiotics. In India, resistance to last resort drug “colistin” is increasing in a bacterium called K. pneumonia which causes serious infections among hospitalized patients. Unfortunately, we do not have any antibiotics to treat colistin resistant K. pneumonia infections.

The three categories include “Access” where global availability of the group of antibiotics is vital; “Watch” where these group of antibiotics require active monitoring because of higher resistance potential and “Reserve” antibiotics that should be used as a last resort treatment options.

How is the categorization expected to help the patients?

The categorization of antibiotics will help reduce unnecessary and inappropriate use of antibiotics by healthcare providers. This would help to extend the life of existing last resort antibiotics and at the same time would reduce the burden of resistant infections.