List Of Essential Medicines Research Articles

Proton Pump Inhibitors: Adversaries In Our Fight Against Antibiotic Resistance?

Madam, The proton-pump inhibitors (PPIs) belong to a class of medications that reduce stomach acid production by irreversibly inhibiting the stomach's H+/K+ ATPase pump. These medications are used in the treatment of many conditions, such aspeptic ulcer, gastroesophageal reflux, as part of H. Pylori eradication, gastrinomas, Barrett’s oesophagus and many other conditions. They are considered to be the most potent inhibitors of acid secretion, and have largely supplanted the H2 receptor antagonists and antacids. They are also among the most widely sold medications worldwide. The class of proton pump inhibitors is listed on WHO’s list of essential medicines.1Proton pump inhibitors are generally well tolerated. However, headache, nausea, diarrhoea, abdominal pain, fatigue, and dizziness are identified as some of the common side effects. Due to their efficacies and low risk profile, PPIs are often prescribed for extend than required period. Several recent studies have shown that long-term PPI use is associated with various adverse outcomes. A 2023 study published in JAMA Network Open demonstrated that long-term use of PPIs may lead to an increased risk of acquiring extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing enterobacterales.2Another study3 published in 2022 showed that PPI use was the only modifiable factor associated with the carriage of ESBL producers in residents of long-term care facilities. These studies add to the expanding list of adverse outcomes associated with PPIs. Other adverse events of long-term PPI use, include the risk of fractures, pneumonia, Clostridium difficile diarrhoea, hypomagnesaemia, vitamin B12deficiency, chronic kidney disease, and dementia.4 Proton pump inhibitors are still used widely in Pakistan. These new findings are concerning as ESBL-producing Enterobacteriaceae are highly prevalent in Pakistan. A meta-analysis showed that the overall pooled proportion of ESBLs in Pakistan is 40%5 whereas the German population showed an estimated ESBL proportion in the range of 10 to 15% and a US census reported 4 to 12% resistance due to ESBLs.5 This calls for a strict prescription control of PPIs by Pakistani physicians, and the duration of PPI use should not extend for longer than needed. In addition, the practice of PPI’s over the counter sale by the pharmacists in Pakistan should be stopped. Additional precautions should be taken in hospitalized patients who are using PPIs to prevent them from getting multi-drug resistant infections.

Essential cancer medicines and cancer outcomes: Cross-sectional study of 124 countries.

Cancer is the second leading cause of death worldwide. Alongside other interventions, access to certain medicines may decrease cancer-associated mortality. Listing medicines on national essential medicines lists may improve health outcomes. We examine the association between cancer mortality amenable to care and the listing of cancer medicines on national essential medicines lists (NEMLs) of 124 countries. In this cross-sectional study, we determined the number of medicines used to treat eight cancers on NEMLs and used multiple linear regression to analyze the association between cancer health outcome scores and the number of medicines on NEMLs while controlling for GDP. A sensitivity analysis was also conducted using selected medicines. The number of cancer medicines on NEMLs was not associated with cancer health outcome scores when GDP was controlled for non-melanoma skin (p = 0.224), uterine (p = 0.221), breast (p = 0.145), Hodgkin's lymphoma (p = 0.697), colon (p = 0.299), leukemia (p = 0.103), cervical (p = 0.834), and testicular cancers (p = 0.178). There was a weak association between listing medicines for eight cancers in NEMLs and amenable mortality. Further studies are required to explore association between cancer health outcomes and other factors such as actual availability of medicines listed, access to surgeries, accurate diagnosis, radiotherapy, and early detection.

Overview of Availability, Cost, and Affordability of Antibiotics for Adults in Jordan: An AWaRe Classification Perspective.

Antimicrobial resistance (AMR) poses a global public health threat, with rates directly linked with consumption. The World Health Organization (WHO)'s AWaRe classification aims to guide antibiotic use, and is influenced by drug availability, affordability, and economic policies. In Jordan, a high proportion of consumed antibiotics belong to the 'Watch' category. Data from the WHO's AWaRe classification, the Essential Medicines List, and the Jordan Food and Drug Administration were analyzed. Antibiotics for adults were classified, their costs per defined daily dose (DDD) were determined and their affordability assessed. In 2023, 43 injectable and 43 oral antibiotics for adults were registered in Jordan. 'Watch' antibiotics were the most common. 'Access' antibiotics had the lowest cost/DDD. 'Reserve' antibiotics were the most expensive, with few generics. Injectable antibiotics had a negative correlation between cost and the number of alternatives. Affordability was higher for oral antibiotics compared with injectable ones. 'Reserve' antibiotics were generally unaffordable. This study highlights the need to promote 'Access' antibiotics over other categories by encouraging the registration of missing 'Access' antibiotics and adjusting the prices of 'Watch' and 'Reserve' antibiotics. Competition among generics can lead to lower prices, increasing affordability and accessibility. We emphasize the importance of the AWaRe classification in guiding antibiotic use in Jordan.

A national survey on registered products, availability, prices, and affordability of 100 essential medicines in community pharmacies across Sri Lanka

IntroductionAvailability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA).MethodsA cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared.FindingsAverage availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2–44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15).ConclusionThe overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products.

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

BackgroundAccess to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn’t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients’ perceived affordability of essential medicines, and accommodation and acceptability of the public facility.MethodsA cross-sectional study was carried out at 30 primary healthcare facilities’ drug dispensaries across three districts in Khartoum state. Within each Centre’s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan’s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26.ResultsParticipants’ ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets.ConclusionPatients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients’ access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients’ satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.

Precision Medicine in Low- and Middle-Income Countries

Dr. Julie Gralow delivered the plenary session on the topic “Precision Medicine in Low- and Middle-Income Countries” during session 7. She explored the barriers to precision oncology in low and middle-income countries. She detailed the examples of initiatives that have improved the availability and accessibility of cancer medicines, such as the World Health Organization model list of essential medicines, the Max Foundation, and the Union for International Cancer Control Access to Oncology Medicines Coalition. She also discussed initiatives that have improved access to diagnostics in low and middle-income countries, such as The American Society of Clinical Pathology Partners for Cancer Diagnosis and Treatment in Africa and the “Spot on CML” test. Some methods to increase the capacity and infrastructure for precision medicine, such as molecular tumor boards and the National Cancer Grid of India, were also discussed. She closed her talk with an appeal to push for equitable access to precision medicine through international cooperation. Following her address, a question-and-answer session brought an end to session 7.

Assessment of Antibiotics Prescribing Patterns at the Outpatient Department of a Specialized Children Hospital in Sri Lanka: Using WHO Recommended Prescribing Indicators

Introduction: "Essential Medicines List," was released by the World Health Organization (WHO) and contains medications including some antibiotics that are considered the most effective and secure ways to fulfil the best patient management. Despite the establishment of standard metrics by the WHO to govern pharmaceutical utilization, irrational prescription is common, particularly in developing countries. Objective: To assess the antibiotics prescribing patterns at the Outpatient Department of Sirimawo Bandaranayake Specialized Children Hospital in Sri Lanka using WHO prescribing indicators. Methodology: A descriptive cross-sectional study was conducted among 375 pediatric patients’ prescription notes aged 1 to 14 years using a data extraction sheet from prescription notes and prescription registration books. The extraction details included the generic name of the drug, number of drugs recommended, presence of antibiotics and mode of administration. Results: The majority of the encounters (52.8%, n=198) included male pediatric patients. The average number of medications administered per encounter was 3, with 6 medications being the highest. In the outpatient department, 46.9% (n=176) of the encounters contained antibiotics while none of the prescriptions contained injectable medications. The majority of the prescriptions (53.6%, n=201) contained drugs that were not from the essential medicines list while 50.1% (n=188) contained medications prescribed using the trade name. Conclusion: In conclusion, polypharmacy, and antibiotics which were not from the essential medicines list were prominent among the prescription sheets issued to pediatric patients.

Rituximab for the treatment of relapsing-remitting multiple sclerosis in Thailand: an economic evaluation and budget impact analysis

BackgroundMultiple sclerosis is an inflammatory demyelination process in the central nervous system (CNS) causing neurological disability and poor quality of life. Currently, Thai Food and Drug Administration (FDA)-approved disease-modifying therapy is costly, and most patients with multiple sclerosis are ineligible for treatment in Thailand as previous studies have challenged its cost-effectiveness. Off-label use of rituximab is inexpensive and highly effective in treating multiple sclerosis, but evidence of its cost-effectiveness in Thailand is yet to be collected.MethodsThis study aimed to evaluate the cost-utility and budget impact of rituximab for multiple sclerosis treatment compared with best supportive care, the standard practice in Thailand to treat the disease. A Markov model with a one-month cycle length and lifetime horizon was applied to compare the costs and outcomes of rituximab and best supportive care based on a societal perspective. Accordingly, incremental cost-effectiveness ratios were estimated. Probabilistic and one-way sensitivity analyses were conducted to investigate parameter uncertainty. In addition, the Markov model was used to assess the 5-year budget impact from the government perspective.ResultsA rituximab biosimilar demonstrated higher effectiveness and lower associated costs, compared to best supportive care, with the highest probability of being cost-effective (96%). The probability of relapse was the most sensitive parameter according to the one-way sensitivity analysis. The calculated budget impact of treating patients with multiple sclerosis in Thailand was 26,360,000 Thai baht (THB) or 844,255 United States dollars (USD) in the first fiscal year, and approximately 20,810,000–23,080,000 THB (666,608–739,388 USD) in the next four fiscal years.ConclusionIn Thailand, a rituximab biosimilar would reduce the overall costs of multiple sclerosis treatment and should, therefore, be included in the National List of Essential Medicines.

Access and use of WHO essential medicines in Italy.

Many countries use the WHO Essential Medicines List (EML) as a guide for health policy choices to promote the efficient use of healthcare resources or adopt the concept of essential medicines (EMs) to develop their own national list of essential medicines. The aim of this study is to analyse the availability and use of medicines included in the 22nd WHO EML in Italy. Using the ATC code (5th level), a comparison was made between the medicines included in the WHO EML and those retrieved from the Italian Medicines Agency (AIFA) database. The availability (regulatory and reimbursement status) of EMs, as well as the market share in expenditure (million euros) and consumption [measured in WHO-defined daily doses (DDDs)], compared to all reimbursed medicines in 2021, were analysed. In 2021, approximately 85.2% (n = 414) of medicines included in the WHO EML were commonly marketed in Italy. Of these, 396 EMs were fully reimbursed by the Italian National Healthcare Service (INHS), corresponding to 81.5% (396/486) of the WHO EML, while the remaining 18.5% (90/486) were neither authorised (n = 72) nor reimbursed (n = 18). The study found a low coverage for anti-parasitic, insecticides, and repellent products (ATC P) in addition to medicines for the genitourinary system and sex hormones (ATC G). Even though medicines on the WHO EML, including therapeutic alternatives, accounted for ~48.5% of the expenditure for medicines reimbursed by INHS, the list covered 74% of all national drug consumed. Novel high-cost therapies indicated in high-prevalence diseases and rare conditions, mostly antineoplastic and immune-modulating agents (ATC L) not included in the WHO EML, were also guaranteed. In Italy, high coverage of EMs was found. It was largely reimbursed by the INHS, even when compared to other European countries. Essential medicines represented a high percentage of the overall expenditure and consumption in Italy. The WHO EML could be an important tool to guide the health policy choices of high-income countries, although a more frequent update and easier access to information on rejected medicines are needed.

The 2023 World Small Animal Veterinary Association (WSAVA): List of essential medicines for cats and dogs.

The 2023 World Small Animal Veterinary Association (WSAVA): List of essential medicines for cats and dogs.

The World Health Organisation's list of essential medicines and haemophilia treatment products.

The World Health Organisation's list of essential medicines and haemophilia treatment products.

Evaluation of Drug Utilization Pattern in Patients with Chronic Kidney Disease

Background: Chronic kidney disease is a major public health issue which requires complex pharmacotherapy. This study was aimed to evaluate drug utilization pattern in chronic kidney disease patients. Method: A prospective observational study was conducted at Nephrology department in Rajiv Gandhi Cooperative Multispecialty hospital, Palakkad for a period of 6 month from July 2022 to January 2023. Medications were assessed by using WHO prescribing indicator and classified in the basis of Anatomic Therapeutic Classification. Results: A total of 120 patients were examined. According to the ATC categorization, out of a total of 921 medicines, cardiovascular drugs were most frequently administered. The average number of drugs per prescription was 7.6%. 11.3% of those medications were prescribed by their generic names. 49.9% of drugs were prescribed on the accordance with essential medicine list. The patient prescribed with an injection was 46% and patients prescribed with antibiotic were 25.5%. Poly pharmacy was executed in 86% of patients. Antihypertensive drugs were most frequently recommended class of drugs followed by hematopoietic drugs and vitamin and minerals in therapeutic wise classification of drugs. Conclusion: Of all drugs prescribed, cardiovascular drugs were commonly prescribed and prevalence of poly pharmacy is high in patients due to co morbidities.

Prescription audit and drug interactions of anti-diabetic drugs at Outpatient Department at a tertiary care teaching hospital in Eastern Nepal

Type 2 diabetes mellitus (T2DM) is the third major non-communicable disease in Nepal. Drug utilization studies help in reducing the patient’s expenditure, adverse drug reactions and drug-drug interactions. It would help in understanding of consumption of drugs including newer ones. Objective was to analyze the prescribing pattern and drug interactions of anti-diabetic drugs. A prospective cross-sectional study was conducted among patients having T2DM at Birat Medical College and Teaching Hospital (BMCTH), Biratnagar, Nepal from May 2019- August 2019. WHO core drug use indicators were used to analyze the obtained data. Descriptive statistics like mean, standard deviation, frequency and percentage were calculated using Microsoft Excel 2013. Out of 200 patients, 104 (52.0%) were females and 49.5% were from the age group of 41-60 years. Average number of drugs per patient was 5.74. Biguanides (40.7%) were the most common prescribed oral antidiabetic drugs followed by Sulfonylureas (23.3%). The percentage of drugs prescribed by generic name and from WHO essential drug list was 0.6% and 15.4% respectively. A total of 95 (47.5%) patients has potential drug-drug interaction (DDI) and it was most common in the age group of 41-60 years (43.2%). Among 95 DDI, Metformin+Amlodipine ranked in 1st position (16 encounters). Polypharmacy was prevalent in the present study. Metformin was the most commonly prescribed anti-diabetic drug. The percentage of drugs from the WHO essential medicine list and prescribed by generic names was low. Prevalence of potential DDI was high.

Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province

BackgroundThe South African National Drug Policy (SA-NDP) was introduced to promote rational medicine use (RMU). This study evaluates the quality of prescribing in the public healthcare sector in South Africa's Limpopo province following the World Health Organization's (WHO) rational prescribing standards. In addition, the prescribing practices in South Africa were compared to other African countries.MethodsA prospective cross-sectional survey of patients' prescriptions was conducted in Limpopo, South Africa, from October to December 2018. Findings were compared with the WHO reference values (WHO-RV), and the International Network of Rational Use of Drugs (IRDP) tool was used to measure the degree of rational prescribing. The optimal IRDP value was defined as 1. Study findings were compared with results from a previous study conducted in Limpopo and studies from Ethiopia and Eritrea.ResultsSix hundred prescriptions were reviewed. The mean (SD) age was 43.9 ± 24.4 years (females = 56.5%). The average number of drugs prescribed (4.3, IRDP = 0.47) was higher than the WHO-RV (< 2). Generic prescribing (43%, IRDP = 0.43) and medicines prescribed from the essential medicines list (EML) (90%, IRDP = 0.90) were less than the WHO-RV (100%, respectively). Antibiotics (28%, IRDP = 1) and the number of injections prescribed (8%, IRDP = 1) were below the WHO-RV (< 30% and < 20%, respectively). The number of medicines prescribed was higher compared to previous years (4.3 vs. 3.4). Antibiotic prescribing declined (28% vs. 63.4%). Generic prescribing (43% vs. 41.7%) and medicines prescribed from the EML (90% vs. 93.1%) did not improve. A higher number of medicines were prescribed in this study compared to Ethiopia (1.7) and Eritrea (1.8), and a lower number of antibiotics were prescribed compared to Ethiopia (58.2%) and Eritrea (54.5%). Generic prescribing was low compared to Ethiopia (95.6%) and Eritrea (94.9%). All studies showed reduced injection prescribing (6.6–15.9%) and similar prescribing from the EML (90–95%).ConclusionsThere is an increased potential for drug-drug and adverse reactions with the increased number of prescribed medicines; however, the patient's clinical needs may warrant using multiple medicines. There is a need for generic prescribing to reduce medicine expenditure.

Ophthalmic Atropine: A Typical Anticholinergic Toxidrome From an Atypical Old Culprit.

Included on the World Health Organization Model Lists of Essential Medicines, atropine remains a cornerstone medication that is used for a myriad of clinical indications. Systemically, atropine carries indications for the treatment of asymptomatic and symptomatic bradycardia, reduction of salivation and bronchial secretions prior to surgery, and as an antidote for a variety of poisoning agents (i.e., carbamate or organophosphate insecticides, nerve agents, muscarine-containing mushrooms). Topically, atropine is administered via the ophthalmic route for the treatment of cycloplegia, mydriasis, and amblyopia or may be administered sublingually to treat chronic sialorrhea. As an anticholinergic, supratherapeutic concentrations of atropine result in a toxidrome typical of other anticholinergic medication overdoses. However, it is easy to overlook atropine as the causative agent when being administered topically, potentially resulting in an unnecessarily extensive and complicated workup. This case report describes the systemic absorption of atropine administered through the ophthalmic route at normal doses, resulting in stroke-like symptoms in an adolescent male. Upon identifying that the patient was being treated with atropine ophthalmic drops prior to hospital arrival, a dose of intravenous physostigmine was administered, resulting in complete reversal of all toxidrome symptoms.

HEALTH JUSTICE AND HEALTH EQUALITY

Dear Reader, The Hathi Committee Report of 1975 on the Drugs &amp; Pharmaceutical Industry, running into 278 pages, was widely discussed in India, both inside and outside Parliament, as well as in many other countries across the globe. The Hathi Committee Report was never implemented in India because of its bold and radical recommendations. However, this report inspired several other countries to frame their National Drug Policies much before India did. The then fledgling neighbour Bangladesh was the first country in the world which bravely enacted the Drug Control Ordinance Law in 1982, against huge resistance from several quarters. This law helped Bangladesh to control the cost and supplies of essential medications, especially for its poor and down trodden masses. The essential medicines list of the World Health Organisation owes a lot to Bangladesh for this revolutionary step. Taking the example of Bangladesh, several developing countries including India formulated their own essential medicines lists. This soon led to the availability of cheap essential medicines. The architect of the Bangladesh Ordinance of 1982 was Dr. Zafrullah Chowdhury, who had concluded by then that Bangladesh needed only 250 drugs while more than 5000 drugs were existing in the market.

Homoeopathy in Clotting

The current article discusses clotting through Pulmonary Embolism (PE), thereafter, it delves in to the epidemiology of PE, its clinical features, management &amp; finally the application of homoeopathy to deal with this issue. It concludes with the cost effectiveness &amp; therapeutic effectiveness of the homoeopathic system of medicine &amp; suggests its involvement on a large scale in the nation. It only reinforces the age old concept of managing these chronic conditions through diet, regimen, exercise &amp; homoeopathy. The suggestion of large scale use of homoeopathy is based on the premise of the modalities of essential medicines. The National List of Essential Medicines (NLEM) envisages that a medicine can be called essential only if it is cost effective, clinically effective &amp; has no side effects. Homoeopathy fits into this triad fully. The article also suggests a treatment protocol based on the typical clinical features of PE &amp; aspires that the public benefits from the protocol at large.

A structured methodology for essential medicines lists and health emergency stockpiles: Experience with the Emergency Medicines Buffer Stock in the United Kingdom

IntroductionFormularies of essential medicines, such as Essential Medicines Lists (EMLs) and health emergency stockpiles, are intended to be always available, including in emergency situations, acting as important tools for access to medicines. The Emergency Medicines Buffer Stock (EMBS) in the United Kingdom (UK) was a stockpile of critical medicines managed by the UK Department of Health and Social Care (DHSC). We propose a new methodology for selecting and including medicines in EMLs and health emergency stockpiles and empirically apply it for selecting medicines in the case of the UK EMBS. MethodsWe used Multi-Attribute Value Theory and Portfolio Decision Analysis to develop a three-phase methodological framework for medicines selection, involving: (i) the decision context definition and selection of evaluation criteria, (ii) the therapeutic area prioritisation, and (iii) the medicines value-for-money evaluation and product selection. The EMBS application took place in 2018–2019 and focused on therapeutic area prioritisation, involving primary data collection through expert interviews (n = 4), a workshop with DHSC decision-makers (n = 13), and an online survey with National Clinical Directors and relevant experts (n = 24). A Monte Carlo simulation supported therapeutic area prioritisation using the British National Formulary (BNF) classification. FindingsTwo criteria sets were selected for i) therapeutic area prioritisation, reflecting the value concerns of population need and shortage severity, and ii) medicines evaluation, reflecting magnitude of clinical benefit and supply vulnerability, among others.Primary evidence was collected for “national need” and “shortage severity”, based on which a “population health loss” index was developed. A total of 51 therapeutic areas were ranked using their index value while assessing the robustness of the ranking. The top ranked therapeutic area was antisecretory drugs and mucosal protectants, closely followed by diabetes drugs. ConclusionsThe methodological application generated a ranking of therapeutic areas based on expected “population health loss” index, while addressing evidence uncertainty. The methodology can be adapted for other EMLs and emergency stockpile contexts to inform medicines selection.

Reforming the World Health Organization’s Essential Medicines List: essential but unaffordable

Reforming the World Health Organization’s Essential Medicines List: essential but unaffordable

Exploring in vitro and in vivo anti-inflammatory activities of the Thai traditional remedy Kheaw-Hom and its bioactive compound, ethyl p-methoxycinnamate, and ethnopharmacological analysis

Ethnopharmacological relevanceKheaw-Hom (KH) remedy, a Thai traditional medicine (TTM) on the National List of Essential Medicines, has long been clinically used to treat fever and inflammation in children. However, no in vitro or in vivo anti-inflammatory or bioactive compound studies are published in the literature. Aims of the studyTo explore the in vitro and in vivo anti-inflammatory activities of KH remedy and its bioactive compound and analyze relationships between flavor and ethnopharmacological activities of plant components in KH remedy according to TTM theory. Materials and methodsEthyl p-methoxycinnamate (EPMC), a bioactive compound of KH remedy was analyzed using high performance liquid chromatography (HPLC). In vitro anti-inflammatory activities of ethanolic extract (KHE), aqueous extract (KHA), acid-hydrolysis of KHA (KHA-h), acid-hydrolysis of KH powder (KHP-h), and EPMC were investigated using lipopolysaccharide (LPS)-induced nitric oxide (NO), prostaglandin E2 (PGE2), and tumor necrosis factor-alpha (TNF-α) production in murine macrophage RAW 264.7 cells. In vivo anti-inflammatory activities of KH powder (KHP) and KHE were determined using carrageenan-induced paw edema and ethyl phenylpropiolate (EPP)-induced ear edema in rats and PGE2 production in tissue samples was examined. ResultsKHP-h showed the highest EPMC content (21.33 ± 1.08 mg/g of extract) and inhibited PGE2, NO, and TNF-α production with IC50 values of 11.92 ± 0.21, 30.61 ± 3.12, and 56.71 ± 2.91 μg/mL, respectively, followed by KHE and KHA-h while KHA did not. EPMC, a bioactive compound of KH remedy showed high anti-inflammatory activities through three pathways. KHP oral administration (100 mg/kg) significantly minimized rat paw inflammation at 1, 2, and 3 h while KHE (100 mg/kg) noticeably reduced at 2 and 3 h. KHP (100, 200, and 400 mg/kg) and KHE (100 mg/kg) significantly inhibited PGE2 production. KHP (1% w/v) notably reduced rat ear edema at 30, 60, and 120 min whereas KHE at all concentrations decreased swelling at 120 min. KHP and KHE at all doses significantly inhibited PGE2 production. Cool flavor was the main KH remedy flavor. Spicy plant components and some fragrant components showed high anti-inflammatory activity. ConclusionsResults from the in vivo study strongly paralleled the in vitro study. These findings support the rational use of KH remedy according to TTM theory for fever treatment and inflammation in children.