The WHO Model List of Essential Medicines has categorized antibiotics into the Access, Surveillance and Standby (AWaRe) categories for the treatment of 31 priority bacterial infections as a tool to facilitate antibiotic management and their optimal use. We compared the list of antibiotics on the National Essential Medicines Lists (NEMLs) to those in the 2019 WHO Model List and the AWaRe classification database to determine how well the NEMLs conform to the framework. AWaRe classification recommended by WHO.
In this cross-sectional study, we obtained up-to-date NEMLs (post-2017 data) from our Global Essential Medicines Database (GEM), WHO online resources and individual country websites. From the 2019 WHO Model List, we have extracted, as a reference standard, a list of 37 antibiotics (44 unique antibiotics after taking into account combination drugs or therapeutically equivalent drugs as specified by the WHO) which were considered essential in the treatment of 31 of the most common and serious. clinical infectious syndromes (priority infections). From the WHO AWaRe classification database, which contains antibiotics commonly used around the world, we extracted a list of 122 AWaRe antibiotics listed by at least one country in the GEM database. We then assessed each country’s NMLs for the list of 44 essential antibiotics and 122 commonly used antibiotics, globally and according to the AWaRe classification group. We also evaluated and summarized the list of first and second choice treatments for the 31 priority infections. A total coverage score was calculated for each country by assigning a treatment score of 0 to 3 for each priority infection based on the inclusion or not of first and second choice treatments, according to the model list of the WHO 2019, in the country’s NEML. . The coverage scores were then compared to the 2019 WHO Model List score and across World Bank income groups and WHO regions.
As of July 7, 2020, we have up-to-date NEMLs for 138 countries. Of the 44 unique essential antibiotics, 24 were Access, 15 were Watch, and five were Reserve. The median number of total essential antibiotics listed in the 138 NMLs was 26 (IQR 21-32). 102 (74%) countries have listed at least 22 (50%) of the 44 essential antibiotics. The median number of total AWaRe antibiotics listed by 138 countries was 35 (IQR 29-46), Access antibiotics was 18 (16-21), Watch antibiotics was 16 (11-22) and d reserve antibiotics was one (0-2). 56 (41%) countries have not identified any reserve essential antibiotics. 131 (95%) countries had coverage scores of at least 60, equivalent to at least 75% of the 2019 WHO Model List score, which was 80. Nine countries (7%) reported less than 12 of 24 essential access antibiotics, and seven (5%) did not report enough first- and second-choice treatments for priority infections (i.e., they had lower coverage scores to 60). Of the 31 priority infections, acute neonatal meningitis and high-risk febrile neutropenia did not have enough treatments listed, with 82 (59%) countries listing no treatment for acute neonatal meningitis and 84 (61%) countries listing only a first choice treatment. , only second-choice treatment, or no treatment for high-risk febrile neutropenia. Coverage scores differed between countries based on World Bank income groups (p = 0.025).
Our results highlight potential modifications of antibiotics included in NML that would increase compliance with international guidelines aimed at effectively treating infectious diseases while combating antimicrobial resistance.
Ontario Patient-Oriented Research Strategy Support Unit of the Canadian and Ontario Institutes of Health Research.