Experts to decide on inclusion and exclusion of antibiotics from NLEM today

New advice on which antibiotics are to be used for common infections and which ones are to be preserved for the most serious medical conditions are likely to be among the additions to the newly revised National List of Essential medicines (NLEM).

The government-appointed experts' committee tasked with preparing the new NLEM will meet today to decide on which group of antibiotics should be included and excluded from the list, in a bid to curb indiscriminate use of antibiotics. The revision of the NLEM aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections.

“The idea to review and revise antibiotics in the NLEM is that it should enhance treatment outcomes, curb drug-resistant bacteria, and preserve the effectiveness of crucial antibiotics that are needed when all others fail,” said an expert, requesting anonymity.

All major pharma companies like Sun pharma, GlaxoSmithKline Pharmaceuticals’ (GSK), Lupin, Torrent, Cipla, Dr Reddys, Alkem Laboratories, Aristo Pharmaceuticals’, Mankind pharma, manufacturer antibiotics in India and the inclusion or deletion of antibiotics from the NLEM will have an impact on them.

The Standing National Committee on Medicine (SNCM), which is working on drafting the revised NLEM, had earlier asked industry experts to get back with their list of antibiotics that they felt was crucial to be removed from the NLEM as Indian population has become resistant to them.

“The meeting of experts on Thursday will review the recommendations it has received from the industry and changes will be made in line with the WHO’s list of essential medicines,” added the expert.

The WHO, in the biggest revision of the antibiotics section in the EML’s 40-year history, have grouped antibiotics into three categories – Access, Watch and Reserve– with recommendations on when each category should be used. According to the WHO’s recommendations the antibiotics in the Access group should 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. The WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

The committee on the National List of Essential Medicines (NLEM) headed by Balram Bhargava, secretary, department of health research and director-general of the Indian Council of Medical Research will decide on those medicines that should be available in adequate numbers and assured quality. “The drugs for which Indian population has become resistant are likely to be removed from the NLEM. The experts are also considering whether the third line antibiotics be included in the NLEM or not,” added another expert.

The issue assumes significance, as according to estimates from a study supported by the UK government and Wellcome Trust in 2016, around 10 million lives a year and a cumulative $100 trillion of economic output will be at risk because of the rise of drug-resistant infections by 2050.

Once the committee experts shortlist the list, it will then be sent to a second committee, comprising Rajiv Kumar, vice-chairman of NITI Aayog, Preeti Sudan, secretary of the health ministry, and P.D Vaghela, secretary of the department of pharmaceuticals, for deciding which ones are to be brought under price control.