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World Health Organization's List of Essential Medicines
Document published by the World Health Organization, containing the most effective and safe medications needed in a health system
2017 marked the 40th anniversary of the WHO Model List of Essential Medicines.
The WHO Model List of Essential Medicines (EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system. The list is frequently used by countries to help develop their own local lists of essential medicine. As of 2016[update], more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list. This includes countries in both the developed and developing world.
The list is divided into core items and complementary items. The core items are deemed to be the most cost effective options for key health problems and are usable with little additional health care resources. The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost-benefit ratio. About 25% of items are in the complementary list. Some medications are listed as both core and complementary. While most medications on the list are available as generic products, being under patent does not preclude inclusion.
The first list was published in 1977 and included 212 medications. The WHO updates the list every two years. The 14th list was published in 2005 and contained 306 medications. In 2015, the 19th edition of the list was published and contains around 410 medications. The 20th edition was published in 2017, and comprises 433 drugs. The 21st list was published in 2019. The national lists contain between 334 and 580 medications.
A separate list for children up to 12 years of age, known as the WHO Model List of Essential Medicines for Children (EMLc), was created in 2007 and is in its 7th edition. It was created to make sure that the needs of children were systematically considered such as availability of proper formulations. Everything in the children's list is also included in the main list. The list and notes are based on the 19th to 21st edition of the main list. An ? indicates a medicine is only on the complementary list.
An ? indicates the medicine is only on the complementary list. For these items specialized diagnostic or monitoring or specialist training are needed. An item may also be listed as complementary on the basis of higher costs or a less attractive cost-benefit ratio.
^Thiopental may be used as an alternative depending on local availability and cost.
^No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
^Not recommended for anti-inflammatory use due to lack of proven benefit to that effect
^cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
^Procaine benzylpenicillin is not recommended as first-line treatment for neonatal sepsis except in settings with high neonatal mortality, when given by trained health workers in cases where hospital care is not achievable.
^single agent trimethoprim may be an alternative for lower urinary tract infection.
^Also listed for single-dose treatment of trachoma and yaws.
^Only listed for acute invasive bacterial diarrhoea (dysentery) or gonorrhoea
^Third-generation cephalosporin of choice for use in hospitalized neonates
^Do not administer with calcium and avoid in infants with hyperbilirubinemia.
^Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
^Imipenem/cilastatin is an alternative, except for acute bacterial meningitis, where meropenem is preferred
^For use only in patients with HIV receiving protease inhibitors
^Includes atenolol, metoprolol and carvedilol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients >60 years
^Hydralazine is listed for use in the acute management of severe pregnancy-induced hypertension only. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines.
^Methyldopa is listed for use in the management of pregnancy-induced hypertension only. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines.
^Wirtz, VJ; Hogerzeil, HV; Gray, AL; Bigdeli, M; de Joncheere, CP; et al. (28 January 2017). "Essential medicines for universal health coverage". The Lancet. 389 (10067): 403-476. doi:10.1016/S0140-6736(16)31599-9. PMID27832874.