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世卫组织更新基本药物清单—新抗生素使用建议
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 WithNew Advice on Antibiotics Use 15 hours ago New advice on which antibiotics to use forcommon infections and which to preserve for the most serious circumstances isamong the additions to the World Health Organization (WHO) model list ofessential medicines for 2017 . Other additions include medicines for HIV,hepatitis C, tuberculosis and leukemia. The updated list adds 30 medicines foradults and 25 for children, and specifies new uses for 9 already-listedproducts, bringing the total to 433 drugs deemed essential for addressing themost important public health needs. The WHO Essential Medicines List (EML) isused by many countries to increase access to medicines and guide decisionsabout which products they ensure are available for their populations. "Safe and effective medicines are anessential part of any health system," said Dr. Marie-Paule Kieny, WHOassistant director-general for health systems and innovation. "Making sureall 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 antibioticssection in the EML’s 40-year history, WHO experts have grouped antibiotics intothree categories – ACCESS, WATCH and RESERVE – with recommendations on wheneach category should be used. Initially, the new categories apply only toantibiotics used to treat 21 of the most common general infections. If shown tobe useful, it could be broadened in future versions of the EML to apply todrugs to treat other infections. The change aims to ensure that antibioticsare available when needed, and that the right antibiotics are prescribed forthe right infections. It should enhance treatment outcomes, reduce thedevelopment of drug-resistant bacteria, and preserve the effectiveness of"last resort" antibiotics that are needed when all others fail. Thesechanges support WHO's Global action plan on antimicrobial resistance, whichaims to fight the development of drug resistance by ensuring the best use ofantibiotics. WHO recommends that antibiotics in theACCESS group be available at all times as treatments for a wide range of commoninfections. For example, it includes amoxicillin, a widely-used antibiotic totreat infections such as pneumonia. The WATCH group includes antibiotics thatare recommended as first- or second-choice treatments for a small number ofinfections. For example, the use of ciprofloxacin, used to treat cystitis (atype of urinary tract infection) and upper respiratory tract infections (suchas bacterial sinusitis and bacterial bronchitis), should be dramaticallyreduced to avoid further development of resistance. The third group, RESERVE, includesantibiotics such as colistin and some cephalosporins that should be consideredlast-resort options, and used only in the most severe circumstances when allother alternatives have failed, such as for life-threatening infections due tomultidrug-resistant bacteria. WHO experts have added 10 antibiotics tothe list for adults, and 12 for children. "The rise in antibiotic resistancestems from how we are using – and misusing – these medicines," said DrSuzanne Hill, Director of Essential Medicines and Health Products. "Thenew WHO list should help health system planners and prescribers ensure peoplewho need antibiotics have access to them, and ensure they get the right one, sothat the problem of resistance doesn’t get worse." The updated EML also includes several newdrugs, such as two oral cancer treatments, a new pill for hepatitis C thatcombines two medicines, a more effective treatment for HIV as well as an olderdrug that can be taken to prevent HIV infection in people at high risk, newpediatric formulations of medicines for tuberculosis, and pain relievers. Thesemedicines are: - two oral cancer medicines (dasatinib and nilotinib)for the treatment of chronic myeloid leukemia that has become resistant tostandard treatment. In clinical trials, one in two patients taking thesemedicines 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 2017-6-9 09:23
