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翻译：陈燕卿
审核：陈志锦
6月6日，世卫组织更新了《世卫组织基本药物标准清单》，关于常见感染和严重感染选用抗生素的建议，还包括艾滋病毒、丙型肝炎、结核病和白血病药物的清单补充。
更新后的《基本药物标准清单》增加了成人药物30种、儿童药物25种；其中成人的10种药物、儿童的12种药物为抗生素；并为9种已上市的药物规定了新用途；共433种药物被列为解决最重要公共卫生需求的基本药物。
这是《基本药物标准清单》40年历史以来抗生素部分的最大修订，世卫组织专家将抗生素分为三类：“可广泛使用”，“谨慎使用”和“保留使用”，并提出了每个类别使用时机的建议。
起初，新类别抗生素仅适用于治疗21种最常见的普通感染。如证实有效，在将来版本的《基本药物标准清单》中可以扩大该药物的适用范围，以用于治疗其他感染。
世卫组织对三类抗生素的建议：
可广泛使用类：随时可用于各种常见感染的治疗，如肺炎等常见感染可使用阿莫西林治疗。
谨慎使用类：包括用于治疗少数感染I级或II级推荐抗生素。例如，应该大幅度减少用于治疗膀胱炎（一种尿路感染）和上呼吸道感染（如细菌性鼻窦炎和细菌性支气管炎）的环丙沙星的使用，以避免耐药性的进一步发展。
保留使用类：应被视为抗生素的最好选择，包括粘菌素和一些头孢菌素，仅在所有其他替代药物失效的最严重的情况中使用。
原文：
WHO Updates Essential Medicines List With New Advice on Antibiotics Use
15 hours ago
New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the World Health Organization (WHO) model list of essential medicines for 2017 . Other additions include medicines for HIV, hepatitis C, tuberculosis and leukemia.
The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The WHO Essential Medicines List (EML) is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations.
"Safe and effective medicines are an essential part of any health system," said Dr. Marie-Paule Kieny, WHO assistant director-general for health systems and innovation. "Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress toward universal health coverage."
In the biggest revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped antibiotics into three categories – ACCESS, WATCH and RESERVE – with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.
The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of "last resort" antibiotics that are needed when all others fail. These changes support WHO's Global action plan on antimicrobial resistance, which aims to fight the development of drug resistance by ensuring the best use of antibiotics.
WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.
The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.
The third group, RESERVE, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.
WHO experts have added 10 antibiotics to the list for adults, and 12 for children.
"The rise in antibiotic resistance stems from how we are using – and misusing – these medicines," said Dr Suzanne Hill, Director of Essential Medicines and Health Products. "The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse."
The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new pediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:
- two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease;
图文编辑：小小牧童
审稿：高晓东 马嘉睿
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发表于 2017-6-8 20:15:28