Essential and Forgotten antibiotics: an inventory in low- and middle-income countries

European Society of Clinical Microbiology; Infectious Diseases Study Group for Antimicrobial Stewardship; Gianpiero Tebano; Grace Li; Bojana Beovic; Julia Bielicki; Adrian Brink; Mushira A. Enani; Brian Godman; Sylvia Lemos Hinrichsen; Dan Kibuule; Levy-Hara Gabriel; Oyinlola Oduyebo; Mike Sharland; Sanjeev Singh; Heiman F.l. Wertheim; Dilip Nathwani; Céline Pulcini

doi:10.1016/j.ijantimicag.2019.06.017

Essential and Forgotten antibiotics: an inventory in low- and middle-income countries

European Society of Clinical Microbiology, Infectious Diseases Study Group for Antimicrobial Stewardship, Gianpiero Tebano (Lead / Corresponding author), Grace Li, Bojana Beovic, Julia Bielicki, Adrian Brink, Mushira A. Enani, Brian Godman, Sylvia Lemos Hinrichsen, Dan Kibuule, Levy-Hara Gabriel, Oyinlola Oduyebo, Mike Sharland, Sanjeev Singh, Heiman F.l. Wertheim, Dilip Nathwani, Céline Pulcini

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	273-282
Number of pages	10
Journal	International Journal of Antimicrobial Agents
Volume	54
Issue number	3
Early online date	28 Jun 2019
DOIs	https://doi.org/10.1016/j.ijantimicag.2019.06.017
Publication status	Published - Sept 2019

Keywords

Access
Antibiotic access
Low- and middle-income countries
Antibiotic stewardship Survey
Survey
Antibiotic stewardship
Prevalence
World Health Organization
Global Health
Humans
Developing Countries
Anti-Bacterial Agents/therapeutic use
Communicable Diseases/drug therapy

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijantimicag.2019.06.017

Author Accepted ManuscriptAccepted author manuscript, 810 KBLicence: CC BY-NC-ND

Cite this

European Society of Clinical Microbiology, Infectious Diseases Study Group for Antimicrobial Stewardship, Tebano, G., Li, G., Beovic, B., Bielicki, J., Brink, A., Enani, M. A., Godman, B., Hinrichsen, S. L., Kibuule, D., Gabriel, L.-H., Oduyebo, O., Sharland, M., Singh, S., Wertheim, H. F. L., Nathwani, D., & Pulcini, C. (2019). Essential and Forgotten antibiotics: an inventory in low- and middle-income countries. International Journal of Antimicrobial Agents, 54(3), 273-282. https://doi.org/10.1016/j.ijantimicag.2019.06.017

@article{66516b2c76a8409ea6d43658832ab315,

title = "Essential and Forgotten antibiotics: an inventory in low- and middle-income countries",

abstract = "Background: The World Health Organization Essential Medicines List (WHO-EML) includes {\textquoteleft}access{\textquoteright} 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 {\textquoteleft}forgotten{\textquoteright} antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. Objective: To investigate which WHO-EML {\textquoteleft}access{\textquoteright} and {\textquoteleft}forgotten{\textquoteright} 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 {\textquoteleft}access{\textquoteright} and 15 {\textquoteleft}forgotten{\textquoteright} 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 {\textquoteleft}access{\textquoteright} antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 {\textquoteleft}access{\textquoteright} antibiotics were approved in more than two-thirds of countries. Among the 15 {\textquoteleft}forgotten{\textquoteright} 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 {\textquoteleft}access{\textquoteright} 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 {\textquoteleft}forgotten{\textquoteright} antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.",

keywords = "Access, Antibiotic access, Low- and middle-income countries, Antibiotic stewardship Survey, Survey, Antibiotic stewardship, Prevalence, World Health Organization, Global Health, Humans, Developing Countries, Anti-Bacterial Agents/therapeutic use, Communicable Diseases/drug therapy",

author = "{European Society of Clinical Microbiology} and {Infectious Diseases Study Group for Antimicrobial Stewardship} and Gianpiero Tebano and Grace Li and Bojana Beovic and Julia Bielicki and Adrian Brink and Enani, {Mushira A.} and Brian Godman and Hinrichsen, {Sylvia Lemos} and Dan Kibuule and Levy-Hara Gabriel and Oyinlola Oduyebo and Mike Sharland and Sanjeev Singh and Wertheim, {Heiman F.l.} and Dilip Nathwani and C{\'e}line Pulcini",

year = "2019",

month = sep,

doi = "10.1016/j.ijantimicag.2019.06.017",

language = "English",

volume = "54",

pages = "273--282",

journal = "International Journal of Antimicrobial Agents",

issn = "0924-8579",

publisher = "Elsevier",

number = "3",

}

European Society of Clinical Microbiology, Infectious Diseases Study Group for Antimicrobial Stewardship, Tebano, G, Li, G, Beovic, B, Bielicki, J, Brink, A, Enani, MA, Godman, B, Hinrichsen, SL, Kibuule, D, Gabriel, L-H, 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. / European Society of Clinical Microbiology; Infectious Diseases Study Group for Antimicrobial Stewardship; Tebano, Gianpiero (Lead / Corresponding author) et al.
In: International Journal of Antimicrobial Agents, Vol. 54, No. 3, 09.2019, p. 273-282.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Essential and Forgotten antibiotics

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

AU - European Society of Clinical Microbiology

AU - Infectious Diseases Study Group for Antimicrobial Stewardship

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 - Gabriel, Levy-Hara

AU - Oduyebo, Oyinlola

AU - Sharland, Mike

AU - Singh, Sanjeev

AU - Wertheim, Heiman F.l.

AU - Nathwani, Dilip

AU - Pulcini, Céline

PY - 2019/9

Y1 - 2019/9

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 - Access

KW - Antibiotic access

KW - Low- and middle-income countries

KW - Antibiotic stewardship Survey

KW - Survey

KW - Antibiotic stewardship

KW - Prevalence

KW - World Health Organization

KW - Global Health

KW - Humans

KW - Developing Countries

KW - Anti-Bacterial Agents/therapeutic use

KW - Communicable Diseases/drug therapy

U2 - 10.1016/j.ijantimicag.2019.06.017

DO - 10.1016/j.ijantimicag.2019.06.017

M3 - Article

C2 - 31260741

SN - 0924-8579

VL - 54

SP - 273

EP - 282

JO - International Journal of Antimicrobial Agents

JF - International Journal of Antimicrobial Agents

IS - 3

ER -

Essential and Forgotten antibiotics: an inventory in low- and middle-income countries

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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