WHO releases list of antibiotics as last resort in superbug infections

By Dr. Ananya Mandal, MDJun 6 2017

This Tuesday (6th June 2017) the World Health Organization came out with a recommendation that some antibiotics should be kept in reserve as the last resort in superbug infections due to the risk of antibiotic resistance worldwide.

The experts suggest that bacteria these days are increasingly developing new strains and are becoming antibiotic-resistant. These new mutant bacteria then become difficult to kill and suppress. They arise out of indiscriminate antibiotic use both in humans as well as in pets and livestock. These bacteria are termed as “nightmare bacteria” by experts and can really lead to catastrophes from simple infections. Minor infections thus may also become deadly very soon and the diseases that were earlier treatable with available antibiotics such as tuberculosis or gonorrhoea, are now becoming a challenge for physicians.

The WHO thus has come up with a new advice. This is the first of its kind in nearly four decades of antibiotic use. They have classified antibiotics into three classes –

• Watch
• Access
• Reserve

This demarcation of antibiotics would help healthcare professionals to always keep in reserve some antibiotics as “last resort” in difficult to treat infections and more serious cases said Marie-Paule Kieny, assistant director-general for health systems and innovation at the WHO from Geneva. She adds that this is in no way a “quick fix” solution to the menace of antibiotic resistance. But for now this is a significant step if it could be implemented to reduce the number of dangerous infections.

The recommendations suggest that penicillins should be used in more cases of infections. This is going back several steps in current practice. This is a significant step in reducing the use of newer and costlier antibiotics.

Thus medicines such as amoxicillin that can work against a wide range of organisms that cause ear infections, chest infections and even skin and soft tissue infections, could be a part of the “access” group said the experts. These should be “available at all times” says the recommendation.

The next group is the “watch” group that includes drugs like Ciprofloxacin. This drug and others of its class are useful in streptococcal infections, sinusitis, ear infections, gastrointestinal infections, typhoid etc. The use of these drugs should be “dramatically reduced,” according to the new recommendations.

The final group is the “reserve group”. These are the high end antibiotics that are the “last resort” in several infections that could quickly become life threatening. Drugs of this class include Colistin, third and fourth generation Cephalosporins etc. According to WHO, These should be used “in the most severe circumstances when all other alternatives have failed.” The severe circumstances defined by WHO include those lethal infections caused by “multidrug-resistant bacteria.”

The new recommendations are published in WHO’s Model Lists of Essential Medicines for 2017. This is routinely updated every couple of years and gives an outline to countries regarding the antibiotics they should stock. Most countries use this list as a guideline based on which they develop their own recommendations, list of Essential medicines, rules and regulations and also insurance rules.

According to Suzanne Hill, director of essential medicines at the WHO, this may have a large impact on the drug makers who thrive on the making of more expensive and newer antibiotics. Going back in practice to standard antibiotics may not be a welcome decision in that case and she suggested the companies could be approached to find a more rational way to do this and that it would be a “challenge” to say the least.