The World Health Organization (WHO) has created new categorisation for antibiotics in its Essential Medicines List, to counter the growing threat of anti-microbial resistance (AMR). Antibiotics used to treat most bacterial infections will now be categorised under ‘Access’, ‘Watch’ and ‘Reserve’ heads. This is an attempt to curb antibiotic misuse, and may help preserve the effectiveness of “last resort” antibiotics. Antibiotics in the Access grouping—certain beta lactams and some other antibiotics—can be prescribed and sold as treatments for a wide range of common infections. These are the first line of treatment for a number of infections—amoxicillin, for instance, can be used to fight pneumonia. The Watch group consists of antibiotics that have a higher resistance potential—like quinolones, third generation cephalosporins and carbapenems—and therefore are recommended as first- or second-choice drugs for only a limited number of indications. The WHO advises thorough monitoring of their prescription and use. The Reserve group contains “last resort” antibiotics like aztreonam, fourth and fifth generation cephalosporins, amongst others. Their use is to be “tailored to highly specific patients and settings, when all alternatives have failed”, i.e., in the case of life-threatening, multi-drug resistant infections. Their use is to be reported to national disease control programmes.
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AMR is reaching scary proportions—in some tropical Asian countries, resistance to the newest anti-malarial on the block, artemisinin, has already been reported. Klebsiella pneumoniae is already resistant to third generation cephalosporins in all of WHO regions, with national reports of over 50% resistance. If antibiotic use is not regulated fast, WHO warns of a post-antibiotic world—the pipeline for new antibiotics had dried up in the past two decades and is only just starting revive. India, with one of the highest per capita antibiotic consumption, needs to toe the WHO line.