The World Health Organization (WHO) on Tuesday published new recommendations that aim to fight drug resistance by reducing the use of certain "last resort" antibiotics.
Drug-resistant infections—caused by so-called superbugs such as Methicillin-resistant Staphylococcus aureus (MRSA) —are a major problem, killing more than 700,000 people globally each year, and in the United States alone they cost about $20 billion annually. CDC has reported that antibiotic-resistant infections kill an estimated 23,000 U.S. residents each year. Experts expect the threat to grow with time as antibiotic overuse and other factors reduce the effectiveness of existing treatments.
Antibiotic resistance recommendations
The new recommendations are part of the WHO's Model Lists of Essential Medicines for 2017, which is updated every two years and is used by many countries to guide what drugs providers should stock. According to WHO, the update is the "biggest revision of the antibiotics section" in the list's 40-year history. According to Reuters, the recommendations take into account the use of antibiotics in animals and were developed in conjunction with the United Nations Food and Agriculture Organisation and the World Organisation for Animal Health.
WHO said it focused its work on 39 essential antibiotics and how they are used to treat 21 of the most common general infections. The new recommendations group antibiotics into three categories:
- Access, which includes drugs that should be "available at all times," including penicillins, which can be used to treat a range of illnesses from ear infections to pneumonia;
- Watch, which includes drugs—including ciprofloxacin—that should be "dramatically reduced" to avoid the emergence of further antibiotic-resistant strains of bacteria; and
- Reserve, which includes antibiotics— including colistin and some cephalosporins—that should be used only as a last resort to treat life-threatening multidrug-resistant bacteria "when all other alternatives have failed."
WHO raised particular concerns with the antibiotic colistin in the face of a superbug, mcr-1, that is resistant to the drug. Suzanne Hill, WHO's director of essential medicines and health products, said, "We don't want colistin used very frequently. In fact, we don't want it used at all."
Marie-Paule Kieny, WHO's assistant director-general for health systems and innovation, said the organization hopes the list will help health systems and providers use antibiotics in a safer and more sustainable way. Kieny said, "We know that where preservation of antibiotics has worked, through hospital stewardship programs, we have seen a reduction in resistance trends."
WHO's 2017 list also added several new drugs as essential medicines, including:
- The oral cancer treatments dasatinib and nilotinib;
- Dolutegravir, for treatment of HIV infection; and
- The first combination therapy for hepatitis C, sofosbuvir + velpatasvir (Eunjung Cha, "To Your Health," Washington Post, 6/6; Miles, Reuters, 6/6; Branswell, STAT News, 6/6; World Health Organization release, 6/6).
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