Essential and forgotten antibiotics

an inventory in low- and middle-income countries

Gianpiero Tebano, Grace Li, Bojana Beovic, Julia Bielicki, Adrian Brink, Mushira A. Enani, Brian Godman, Sylvia Lemos Hinrichsen, Dan Kibuule, Gabriel Levy Hara, Oyinlola Oduyebo, Mike Sharland, Sanjeev Singh, Heiman F. L. Wertheim, Dilip Nathwani, Céline Pulcini

Research output: Contribution to journalArticle

Abstract

Background: The World Health Organization Essential Medicines List (WHO-EML) includes ‘access’ antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of ‘forgotten’ antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective: To investigate which WHO-EML ‘access’ and ‘forgotten’ antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). Methods: The Scientific Committee used a consensus procedure to select 26 WHO-EML ‘access’ and 15 ‘forgotten’ antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. Results: Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML ‘access’ antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 ‘access’ antibiotics were approved in more than two-thirds of countries. Among the 15 ‘forgotten’ antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23–35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. Conclusions: WHO-EML ‘access’ antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the ‘forgotten’ antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.

Original languageEnglish
Pages (from-to)273-282
Number of pages10
JournalInternational Journal of Antimicrobial Agents
Volume54
Issue number3
Early online date28 Jun 2019
DOIs
Publication statusPublished - 30 Sep 2019

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Anti-Bacterial Agents
Equipment and Supplies
Amoxicillin
Metronidazole
Pediatrics
Amoxicillin-Potassium Clavulanate Combination
Penicillin G
Clarithromycin
Ceftriaxone
Doxycycline
Sulfamethoxazole Drug Combination Trimethoprim
Erythromycin
Ampicillin
Ciprofloxacin
Gentamicins
Penicillins
Pharmaceutical Preparations
Internet
Bacteria
Health

Keywords

  • antibiotic access
  • antibiotic stewardship
  • low income countries
  • middle income countries

Cite this

Tebano, Gianpiero ; Li, Grace ; Beovic, Bojana ; Bielicki, Julia ; Brink, Adrian ; Enani, Mushira A. ; Godman, Brian ; Hinrichsen, Sylvia Lemos ; Kibuule, Dan ; Hara, Gabriel Levy ; Oduyebo, Oyinlola ; Sharland, Mike ; Singh, Sanjeev ; Wertheim, Heiman F. L. ; Nathwani, Dilip ; Pulcini, Céline. / Essential and forgotten antibiotics : an inventory in low- and middle-income countries. In: International Journal of Antimicrobial Agents. 2019 ; Vol. 54, No. 3. pp. 273-282.
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abstract = "Background: The World Health Organization Essential Medicines List (WHO-EML) includes ‘access’ antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of ‘forgotten’ antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective: To investigate which WHO-EML ‘access’ and ‘forgotten’ antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). Methods: The Scientific Committee used a consensus procedure to select 26 WHO-EML ‘access’ and 15 ‘forgotten’ antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. Results: Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML ‘access’ antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 ‘access’ antibiotics were approved in more than two-thirds of countries. Among the 15 ‘forgotten’ antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23–35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. Conclusions: WHO-EML ‘access’ antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the ‘forgotten’ antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.",
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Tebano, G, Li, G, Beovic, B, Bielicki, J, Brink, A, Enani, MA, Godman, B, Hinrichsen, SL, Kibuule, D, Hara, GL, Oduyebo, O, Sharland, M, Singh, S, Wertheim, HFL, Nathwani, D & Pulcini, C 2019, 'Essential and forgotten antibiotics: an inventory in low- and middle-income countries', International Journal of Antimicrobial Agents, vol. 54, no. 3, pp. 273-282. https://doi.org/10.1016/j.ijantimicag.2019.06.017

Essential and forgotten antibiotics : an inventory in low- and middle-income countries. / Tebano, Gianpiero; Li, Grace; Beovic, Bojana; Bielicki, Julia; Brink, Adrian; Enani, Mushira A.; Godman, Brian; Hinrichsen, Sylvia Lemos; Kibuule, Dan; Hara, Gabriel Levy; Oduyebo, Oyinlola; Sharland, Mike; Singh, Sanjeev; Wertheim, Heiman F. L.; Nathwani, Dilip; Pulcini, Céline.

In: International Journal of Antimicrobial Agents, Vol. 54, No. 3, 30.09.2019, p. 273-282.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Essential and forgotten antibiotics

T2 - an inventory in low- and middle-income countries

AU - Tebano, Gianpiero

AU - Li, Grace

AU - Beovic, Bojana

AU - Bielicki, Julia

AU - Brink, Adrian

AU - Enani, Mushira A.

AU - Godman, Brian

AU - Hinrichsen, Sylvia Lemos

AU - Kibuule, Dan

AU - Hara, Gabriel Levy

AU - Oduyebo, Oyinlola

AU - Sharland, Mike

AU - Singh, Sanjeev

AU - Wertheim, Heiman F. L.

AU - Nathwani, Dilip

AU - Pulcini, Céline

PY - 2019/9/30

Y1 - 2019/9/30

N2 - Background: The World Health Organization Essential Medicines List (WHO-EML) includes ‘access’ antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of ‘forgotten’ antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective: To investigate which WHO-EML ‘access’ and ‘forgotten’ antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). Methods: The Scientific Committee used a consensus procedure to select 26 WHO-EML ‘access’ and 15 ‘forgotten’ antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. Results: Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML ‘access’ antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 ‘access’ antibiotics were approved in more than two-thirds of countries. Among the 15 ‘forgotten’ antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23–35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. Conclusions: WHO-EML ‘access’ antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the ‘forgotten’ antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.

AB - Background: The World Health Organization Essential Medicines List (WHO-EML) includes ‘access’ antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of ‘forgotten’ antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective: To investigate which WHO-EML ‘access’ and ‘forgotten’ antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). Methods: The Scientific Committee used a consensus procedure to select 26 WHO-EML ‘access’ and 15 ‘forgotten’ antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. Results: Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML ‘access’ antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 ‘access’ antibiotics were approved in more than two-thirds of countries. Among the 15 ‘forgotten’ antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23–35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. Conclusions: WHO-EML ‘access’ antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the ‘forgotten’ antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.

KW - antibiotic access

KW - antibiotic stewardship

KW - low income countries

KW - middle income countries

U2 - 10.1016/j.ijantimicag.2019.06.017

DO - 10.1016/j.ijantimicag.2019.06.017

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EP - 282

JO - International Journal of Antimicrobial Agents

JF - International Journal of Antimicrobial Agents

SN - 0924-8579

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