Model List Of Essential Medicines Research Articles

Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018.

BackgroundIn 2019, the World Health Organization published the 21st Model list of Essential Medicines and updated the Access, Watch Reserve (AWaRe) antibiotics classification to improve metrics and indicators for antibiotic stewardship activities. Reserve antibiotics are regarded as last-resort treatment options.AimWe investigated hospital-sector consumption quantities and trends of Reserve group antibiotics in European Union/European Economic Area countries and the United Kingdom (EU/EEA/UK).MethodsHospital-sector antimicrobial consumption data for 2010–2018 were obtained from the European Centre for Disease Prevention and Control. Antibacterials’ consumption for systemic use (Anatomical Therapeutic Chemical classification (ATC) group J01) were included in the analysis and expressed as defined daily doses (DDD) per 1,000 inhabitants per day. We defined reserve antibiotics as per AWaRe classification and applied linear regression to analyse trends in consumption of reserve antibiotics throughout the study period.ResultsEU/EEA/UK average hospital-sector reserve-antibiotic consumption increased from 0.017 to 0.050 DDD per 1,000 inhabitants per day over the study period (p = 0.002). This significant increase concerned 15 countries. In 2018, four antibiotics (tigecycline, colistin, linezolid and daptomycin) constituted 91% of the consumption. Both absolute and relative (% of total hospital sector) consumption of reserve antibiotics varied considerably (up to 42-fold) between countries (from 0.004 to 0.155 DDD per 1,000 inhabitants per day and from 0.2% to 9.3%, respectively).ConclusionAn increasing trend in reserve antibiotic consumption was found in Europe. The substantial variation between countries may reflect the burden of infection with multidrug-resistant bacteria. Our results could guide national actions or optimisation of reserve antibiotic use.

World Health Organization model list of essential medicines for children – 8th list, 2021

World Health Organization model list of essential medicines for children – 8th list, 2021

US drug shortages compared to the World Health Organization's Model List of Essential Medicines for Children: A cross-sectional study.

To describe US drug shortages affecting medications on the 2019 World Health Organization (WHO) Model List of Essential Medicines for Children (EMLc). Drug shortage data from January 2014 to December 2019 were obtained from the University of Utah Drug Information Service. Shortage data for drugs on the EMLc were analyzed for the type of drug, American Hospital Formulary Service category, reason for the shortage, duration of the shortage, marketing status (generic vs brand name), and whether the agent was a single- or multisource drug. From 2014 to 2019, a total of 209 drug shortages impacted medications on the EMLc, of which 77 (36.8%) remained unresolved by 2019. Of all active shortages, 13 (6.2%) began before 2014. Resolved shortages had a median duration of 5.9 months (interquartile range [IQR], 3.6-13.2 months) while active shortages had a median duration of 18.3 months (IQR, 10.9-33.5 months; P ≤ 0.0001). The therapeutic categories most impacted by drug shortages were anti-infective agents (27.3%), central nervous system agents (12.9%), and antineoplastic agents (11.0%). The reason for the shortage was not reported in 46.4% of cases. When a reason was provided, the most common reason was manufacturing problems (29.2%) followed by supply/demand mismatch (15.8%). US drug shortages affected many medications on the WHO EMLc. Future studies should examine the global shortage climate and implications for patient care.

PRESCRIPTION PATTERN ANALYSIS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN TERTIARY CARE HOSPITAL

Objective: The aim of the study was to analyze the prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and to identify the commonly used NSAIDs and their drug-related problems (DRPs). Methods: A prospective and cross-sectional study on prescription pattern analysis of NSAIDs was conducted for the period of 6 months. Results: Prescriptions of 150 patients containing at least one NSAIDs were analyzed. About 56% of the prescription were prescribed for males and 44% prescription were female. NSAIDs were more prescribed for below 60-year age group (47%) but were most frequently used by 61–70-year age group (21%). Subjects were regularly prescribed with acetaminophen (95%) and diclofenac (22%). Among all the prescriptions, (19%) of the prescriptions contained NSAIDs in the form of fixed dose combinations (FDCs). About 37% of prescriptions had other analgesic coprescribed along with NSAIDs amid which tramadol was in majority (22%). Prescription was also coprescribed with antibiotic (90%) and gastroprotective agents (GPAs) (97%) that consisted of pantoprazole belonging to the class of proton pump inhibitors which was the persistently prescribed GPA (86%). Due to coprescription, (3%) suspected drug-drug interactions (DDIs) were observed. Conclusion: The goal of studying prescribing patterns was to monitor, assess, and, if required, advise changes in medical practitioners’ prescribing behavior to offer quality medical treatment and reasonable drug use. The prescribing pattern was rational and in accordance with national list of essential medicine (NLEM-2015) but was not in accordance with the World Health Organization (WHO) model list of essential medicines.

Availability of essential medicines for children with cancer in Sri Lanka: a prospective cohort study

The WHO Model List of Essential Medicines for children (2019 version) contains 39 antineoplastic and supportive medicines deemed essential for the successful treatment of children with cancer. The availability of these medicines varies across countries, but most reports are retrospective or short term. This study tracked the availability of these medicines in Sri Lanka's only treatment centre for childhood cancer, the National Cancer Institute of Sri Lanka, over 1 year, and examined initial mitigation strategies and implications. We prospectively tracked the availability of essential medicines at the National Cancer Institute of Sri Lanka in a customised database from April 1, 2019, to March 31, 2020. Consumption volumes and unit prices were extracted from the Sri Lankan Ministry of Health's Medical Supplies Management Information System. Availability was mapped against regimens used to treat childhood cancers, including WHO Global Initiative for Childhood Cancer index cancers, in Sri Lanka and by the International Society of Paediatric Oncology. Descriptive analyses and linear regression were used to assess factors associated with the unavailability of medicines. 31 (79%) of 39 medicines listed in the WHO Model List of Essential Medicines for children are in the Sri Lankan Essential Medicine List and 36 (92%) of 39 (48 formulations) are registered for use. Thioguanine, arsenic, and realgar-Indigo naturalis were the unregistered medicines. Over the study period, less than half (17 [44%]) of medicines were consistently available for 100% of the study period, 14 (36%) were available 75-100% of the study period, three (8%) between 50-75% of the study period, and two (5%) for less than 50% of the duration of the study period. The least available drug was procarbazine (available only on 212 [58%] of 366 days in the total study period). The availability of medicines did not reach 100% on any day in the study period. No substantial monthly variability was noted, but the best availability was in August, 2019, and the worst in January, 2020. Applying regimen-based analyses for acute lymphoblastic leukaemia, 12 stockout episodes affected seven (18%) medicines (median 37·5 consecutive days, IQR 12·0-62·0), whereas stockout mitigation strategies (low stock periods not resulting in stockout) were effective in 11 instances; only three (8%) medicines did not have alternate formulations or substitutions during stockouts (vincristine, cytarabine, and mercaptopurine). Of the WHO Global Initiative for Childhood Cancer index cancers, Hodgkin lymphoma was the most affected by stockouts, and retinoblastoma was the least affected. Annual consumption volumes (p=0·13), unit cost (p=0·5), and annual costs per medicine (p=0·091) were not significantly associated with medicine unavailability. Non-availability of essential medicines is an important problem to be addressed for children with cancer in Sri Lanka. This study showed the feasibility of prospective essential medicines tracking at the point-of-care, and how data visibility can inform stock and inventory management and help to identify mitigation strategies for stockouts. None.

Targeting Affective Mood Disorders With Ketamine to Prevent Chronic Postsurgical Pain.

The phencyclidine-derivative ketamine [2-(2-chlorophenyl)-2-(methylamino)cyclohexan-1-one] was added to the World Health Organization's Model List of Essential Medicines in 1985 and is also on the Model List of Essential Medicines for Children due to its efficacy and safety as an intravenous anesthetic. In sub-anesthetic doses, ketamine is an effective analgesic for the treatment of acute pain (such as may occur in the perioperative setting). Additionally, ketamine may have efficacy in relieving some forms of chronic pain. In 2019, Janssen Pharmaceuticals received regulatory-approval in both the United States and Europe for use of the S-enantiomer of ketamine in adults living with treatment-resistant major depressive disorder. Pre-existing anxiety/depression and the severity of postoperative pain are risk factors for development of chronic postsurgical pain. An important question is whether short-term administration of ketamine can prevent the conversion of acute postsurgical pain to chronic postsurgical pain. Here, we have reviewed ketamine's effects on the biopsychological processes underlying pain perception and affective mood disorders, focusing on non-NMDA receptor-mediated effects, with an emphasis on results from human trials where available.

Access to flucytosine for the treatment of HIV-associated cryptococcal meningitis in Africa

Cryptococcal meningitis, a major cause of meningitis in adults living with HIV infection, accounts for 15% of global HIV-associated mortality. 1 Rajasingham R Smith RM Park BJ et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017; 17: 873-881 Summary Full Text Full Text PDF PubMed Scopus (973) Google Scholar Treatment of cryptococcal meningitis involves three phases: induction, consolidation, and maintenance. The induction phase, which aims at reducing cerebral and meningeal fungal burden crucial for early survival, requires combination antifungal therapy and management of increased cerebrospinal fluid intracranial pressure. WHO in 2018 recommended at induction either 1-week amphotericin B deoxycholate plus flucytosine followed by high-dose fluconazole or 2-week oral fluconazole plus flucytosine. 2 WHOGuidelines for the diagnosis, prevention, and management of cryptococcal disease in HIV-infected adults, adolescents and children. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. https://www.who.int/publications/i/item/9789241550277Date: 2018 Date accessed: April 14, 2022 Google Scholar However, in the absence of flucytosine, fluconazole plus amphotericin B deoxycholate could be an alternative. The Advancing Cryptococcal Meningitis treatment for Africa trial on which these recommendations were based showed flucytosine to be a better drug at reducing mortality than is fluconazole in combination with amphotericin B deoxycholate. 3 Molloy SF Kanyama C Heyderman RS et al. Antifungal combinations for treatment of cryptococcal meningitis in Africa. N Engl J Med. 2018; 378: 1004-1017 Crossref PubMed Scopus (176) Google Scholar In a recent trial, a combination of single dose 10 mg/kg liposomal amphotericin B and 2-week flucytosine plus fluconazole showed non-inferiority and tolerance benefits to previously recommended induction therapy. 4 Jarvis JN Lawrence DS Meya DB et al. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis. N Engl J Med. 2022; 386: 1109-1120 Crossref PubMed Scopus (9) Google Scholar These trials and some observational studies 5 Dromer F Mathoulin-Pelissier S Launay O Lortholary O French Cryptococcosis Study GDeterminants of disease presentation and outcome during cryptococcosis: the CryptoA/D study. PLoS Med. 2007; 4: e21 Crossref PubMed Scopus (280) Google Scholar provide data that confirm flucytosine as an important drug combination for inductive treatment of cryptococcal meningitis. However, access to this old, off patent drug is not guaranteed in Africa, South America, and Asia where the burden of cryptococcal meningitis is highest. 6 Loyse A Dromer F Day J Lortholary O Harrison TS Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal. J Antimicrob Chemother. 2013; 68: 2435-2444 Crossref PubMed Scopus (83) Google Scholar In South Africa, a region with a long-standing high burden of cryptococcal meningitis, flucytosine was only registered in December, 2021, by the South African Health Products Regulatory Authority (SAHPRA) despite the application being submitted 2 years previously by Viatris. 7 Application for WHO Model List of Essential Medicines: flucytosine (5FC). http://www.life-worldwide.org/assets/uploads/files/Flucytosine_63_CORE_AC.pdfDate: 2018 Date accessed: April 24, 2022 Google Scholar Outcomes of flucytosine-containing combination treatment for cryptococcal meningitis in a South African national access programme: a cross-sectional observational studyIn-hospital mortality among patients treated with a flucytosine-containing regimen was comparable to reduced mortality reported in patients receiving a flucytosine-containing regimen in a recent multicentre African clinical trial. Flucytosine-based treatment can be delivered in routine care in a middle-income country with a substantial survival benefit. Full-Text PDF

Defining Essential Childhood Cancer Medicines to Inform Prioritization and Access: Results From an International, Cross-Sectional Survey.

PURPOSEAccess to essential cancer medicines is a major determinant of childhood cancer outcomes globally. The degree to which pediatric oncologists deem medicines listed on WHO's Model List of Essential Medicines for Children (EMLc) essential is unknown, as is the extent to which such medicines are accessible on the front lines of clinical care.METHODSAn electronic survey developed was distributed through the International Society of Pediatric Oncology mailing list to members from 87 countries. Respondents were asked to select 10 cancer medicines that would provide the greatest benefit to patients in their context; subsequent questions explored medicine availability and cost. Descriptive and bivariate statistics compared access to medicines between low- and lower-middle–income countries (LMICs), upper-middle–income countries (UMICs), and high-income countries (HICs).RESULTSAmong 159 respondents from 44 countries, 43 (27%) were from LMICs, 79 (50%) from UMICs, and 37 (23%) from HICs. The top five medicines were methotrexate (75%), vincristine (74%), doxorubicin (74%), cyclophosphamide (69%), and cytarabine (65%). Of the priority medicines identified, 87% (27 of 31) are represented on the 2021 EMLc and 77% (24 of 31) were common to the lists generated by LMIC, UMIC, and HIC respondents. The proportion of respondents indicating universal availability for each of the top medicines ranged from 9% to 46% for LMIC, 25% to 89% for UMIC, and 67% to 100% for HIC. Risk of catastrophic expenditure was more common in LMIC (8%-20%), compared with UMIC (0%-28%) and HIC (0%).CONCLUSIONMost medicines that oncologists deem essential for childhood cancer treatment are currently included on the EMLc. Barriers remain in access to these medicines, characterized by gaps in availability and risks of catastrophic expenditure for families that are most pronounced in low-income settings but evident across all income contexts.

Comparison of the 22nd World Health Organization Model List of Essential Medicines with the explicit criteria for the treatment of chronicity in elderly patients

ObjectivesThis study analysed whether the Model List of Essential Medicines is suitable for elderly patients. Furthermore, it investigated the specific issues that should be considered when prescribing a drug and...

National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis.

The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Supporting the Use of Research Evidence (SURE) framework, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. PROSPERO CRD42018104112.

A comprehensive look at explicit screening tools for potentially inappropriate medication: A systematic scoping review.

To map explicit screening tools to identify potentially inappropriate medication (PIMs), and the characteristics and limitations of these tools. Including PIMs-interactions, therapeutic alternatives and the clinical management of PIMs. A systematic scoping review was conducted in PubMed and Scopus (until May 2021). The number of PIMs listed as essential drugs was identified in Model List of Essential Medicines by the World Health Organization (WHO) and National List of Essential Medicines (Brazil). In addition to reporting the therapeutic alternatives and clinical management proposed by explicit screening tools to identify PIMs, we suggested our own alternatives for the PIMs most frequently reported. Fifty-eight tools reported 614 PIMs and 747 PIMs-interactions. Limited overlap between the tools was observed: 123 (69.1%) of 178 therapeutic alternatives proposed by the tools were considered inappropriate by other tools, and 222 (36.1%) of the 614 PIMs identified were named as being inappropriate only once. Only 21 tools were developed by a Delphi panel technique associated with systematic review. The PIMs listed as essential medication in Brazil and by the WHO were 30.6% and 23.3% of the total reported, respectively. For the most-cited PIMs, such as non-steroidal anti-inflammatory drugs, tricyclic antidepressants and benzodiazepines, we suggested the use of non-opioid and opioid analgesics; agomelatine, bupropion or moclobemide; and melatonin, respectively. The next stages in the development of explicit screening tools to identify PIMs include achieving more consensus between them and improving their applicability across countries. Further, it is recommended that tools include PIMs risks and advice on therapeutic alternatives.

Evaluation of rationality of fixed dose combinations of antimicrobials available in Indian market

Background: The antimicrobial resistance is alarming at present. One of the important factors for resistance is use of irrational fixed dose combinations. Thus, objective was to critically analyze the rationality of FDCs of antimicrobial agents currently available in India.Methods: The FDCs of AMAs enlisted in Indian Drug Review 2019 were analyzed by 8 point criteria tool. Analysis includes number of active pharmacological ingredients, approval by central drug standard control organization, listing in world health organization model list of essential medicines (2019) or Government of India national list of essential medicines (2015). Literature search was used for assessing efficacy, safety, pharmacokinetic and pharmacodynamic interactions and advantages of each FDC. Each criterion was assigned score one, if positive and minus one, if negative leading to total score of 12. FDC with score of ≥7 was considered as rational. Results: The FDCs of AMA available in Indian market were 116 while FDCs included in WHO model list, 2019 were 24. Majority of FDCs available were irrational that include combination of antibacterial with bromhexine, carbocisteine, ambroxol, serratiopeptidase, antiamoebic and antifungal etc. Most of the rational FDCs belong to antiretroviral, antitubercular and antimalarial drugs. Conclusions: Most of the FDCs of AMAs available in Indian market are irrational. These needs educating the prescribers including resident doctors. There is need to critically review such FDCs by drug regulators with strict action regarding manufacturing and marketing.

Assessing the Appropriateness of Formulations on the WHO Model List of Essential Medicines for Children: Development of a Paediatric Quality Target Product Profile Tool.

The World Health Organization’s Model List of Essential Medicines for Children (EMLc) presents a list of the most efficacious, safe, and cost-effective medicines for priority conditions, intended for use in children up to 12 years of age. However, gaps in global availability and use of age-appropriate formulations of medicines for children still exist. To address these shortcomings, a comprehensive analysis of the appropriateness of formulations of essential medicines for children is being undertaken through the Global Accelerator for Paediatric Formulations (GAP-f) network, a WHO network launched in 2020 to respond to the paediatric treatment gap. This article describes the development and application of a paediatric Quality Target Product Profile (pQTPP) tool by WHO, to retrospectively evaluate the paediatric age-appropriateness of formulations on the EMLc and identify potential formulation gaps, to inform the review of the EMLc in 2023. A combination of paediatric-centric and global health-focused attributes and targets were defined, taking into consideration regulatory agency paediatric development guidelines and literature sources, and a qualitative scoring system was developed and tested. Example evaluations of paracetamol and clofazimine are provided, illustrating the tool’s use. The assessment of EMLc formulations is ongoing and shortcomings and gaps in EMLc formulations have already been identified. The pQTTP tool may also be applied to national lists and prospectively when designing new paediatric formulations.

Bioconjugation strategies and clinical implications of Interferon-bioconjugates

Interferons (IFN) are immunomodulating, antiviral and antiproliferative cytokines for treatment of multiple indications, including cancer, hepatitis, and autoimmune disease. The first IFNs were discovered in 1957, first approved in 1986, and are nowadays listed in the WHO model list of essential medicines. Three classes of IFNs are known; IFN-α2a and IFN-β belonging to type-I IFNs, IFN-γ a type-II IFN approved for some hereditary diseases and IFN-λs, which form the newest class of type-III IFNs. IFN-λs were discovered in the last decade with fascinating yet under discovered pharmaceutical potential. This article reviews available IFN drugs, their field and route of application, while also outlining available and future strategies for bioconjugation to further optimize pharmaceutical and clinical performances of all three available IFN classes.

Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO

ObjectivesExamining the availability of essential medicines is a necessary step to monitor country-level progress towards universal health coverage. We compared the 2017 essential medicine lists (EML) of 137 countries to...

Addition of direct oral anticoagulants to the World Health Organization model list of essential medicines for the treatment of atrial fibrillation: An African perspective.

Atrial fibrillation (AF) is a major cause of adverse cardiovascular outcomes, and its prevalence is fast rising in Africa. The advent of direct oral anticoagulants (DOACs) has been a major revolution for the prevention of AF-related stroke and systemic embolism given the significant advantage over vitamin K antagonists in terms of both efficacy, safety, and adherence. However, due to their high cost, equitable access to DOACs has been a challenge, especially in low- and middle-income countries. Therefore, the recent addition of DOACs to the 21st WHO list of essential medicines comes as good news. African governments should take this opportunity to scale up the accessibility to DOACs for African patients with AF. This could be achieved through advocacy, appropriate training of health professionals, task shifting, patient education, strategic partnership to increase availability and quality of low-cost generic drugs, and appropriate medico-economic studies.

Disparities in Access to Systemic Treatment for Breast Cancer in Thailand and Major Asian Territories.

PurposeBreast cancer (BC) treatment has shifted from chemotherapy to targeted therapy. Several targeted agents have demonstrated an improvement in survival. Given that national healthcare resources were correlated with the cancer mortality-to-incidence ratio, we compared access to BC drugs in Thailand with that in other Asian countries.MethodsBC experts involved in the Breast International Group (BIG)-Asia in six representative groups for countries or special administrative region (SAR) in Asia (Hong Kong SAR, Japan, Korea, Taiwan, Thailand, and Singapore) were invited to participate in the survey. The questionnaire addressed national health reimbursement schemes, molecular testing for early BC (EBC), availability and accessibility of BC drugs. Accessibility and reimbursement of the drugs were reported based on their listing as essential medicines in the World Health Organization Model List of Essential Medicines (WHO-EML) and their nomination as effective drugs in the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS). The study was approved by all participating BIG-Asia organizations in November 2021.ResultsGenomic tests for EBC were non-reimbursable in all surveyed territories. Reimbursement and co-payment of BC drugs vary between and within these regions (particularly Thailand). Most drugs in the WHO-EML and ESMO-MCBS (A/B for EBC and 4/5 for advanced BC) were accessible in all surveyed territories. However, the accessibility of effective but costly WHO-EML and ESMO-MCBS drugs was not uniform in Thailand. There was an evident disparity for individuals covered by the Thai Social Security/Universal Health Coverage schemes.ConclusionEssential BC drugs are generally accessible in selected BIG-Asia countries or SAR. There is a disparity in accessing high-cost drugs in Thailand compared with other Asian territories.

Low-Cost Drugs Still Relevant in the Present-Day Era

Escalating medical costs contribute to poverty in countries with low resources. The drug costs account for 17 percent of medical expenses. Revisiting time-tested, cost-effective drugs can reduce these costs. Some of them find a place in the WHO Model List of Essential Medicines for Children. The list consists of medicines for a basic healthcare system. They are safe and cost-effective. The present paper identifies co-trimoxazole and chloramphenicol as antimicrobials, chloroquine for malaria, adrenaline, theophylline for asthma, and phenobarbital as an anti-epileptic drug that merits consideration for reviving interest in them and reduce drug treatment costs. 
 What is already known about this subject?
 • The cost of drugs contributes to rising medical costs.
 • Medical expenses push a large population below the poverty line.
 What does this study add?
 • Rediscovering the relevance of old low-cost drugs is essential.
 • Revisiting the WHO Model List of Essential Medicines for Children may be useful. 
 • Drugs such as chloramphenicol and theophylline are such examples.

Combined Use of Cyclodextrins and Amino Acids for the Development of Cefixime Oral Solutions for Pediatric Use.

Cefixime (CEF) is a cephalosporin included in the WHO Model List of Essential Medicines for Children. Liquid formulations are considered the best choice for pediatric use, due to their great ease of administration and dose-adaptability. Owing to its very low aqueous solubility and poor stability, CEF is only available as a powder for oral suspensions, which can lead to reduced compliance by children, due to its unpleasant texture and taste, and possible non-homogeneous dosage. The aim of this work was to develop an oral pediatric CEF solution endowed with good palatability, exploiting the solubilizing and taste-masking properties of cyclodextrins (CDs), joined to the use of amino acids as an auxiliary third component. Solubility studies indicated sulfobutylether-β-cyclodextrin (SBEβCD) and Histidine (His) as the most effective CD and amino acid, respectively, even though no synergistic effect on drug solubility improvement by their combined use was found. Molecular Dynamic and 1H-NMR studies provided insight into the interactions of binary CEF:His and ternary CEF:His:SBEβCD systems used to prepare CEF solutions, which resulted stable and maintained unchanged antimicrobial activity during the two-weeks-use in therapy. The ternary solution was superior in terms of more tolerable pH (5.6 vs. 4.7) and better palatability, being resulted completely odorless by a panel test.

Dermatology on the global stage: The role of dermatologists in international health advocacy and COVID-19 research.

BackgroundOver the last decade, there has been a surge in interest and funding for global health dermatology. Skin conditions are now recognized as the fourth leading cause of nonfatal disease burden worldwide in disability-adjusted life years. Dermatologists are uniquely positioned within global health because skin conditions are often the presenting sign of severe illnesses, such as neglected tropical diseases and COVID-19.MethodsWe review four major areas of work by dermatologists within global health: i) characterization of global burden of skin disease, ii) advocacy for dermatologic therapies on the World Health Organization's Model List of Essential Medicines, iii) advancements in global programming for skin-related tropical diseases, and iv) the role of dermatologists during the COVID-19 pandemic. For each area of work, the significance and impact on the health of women and girls is briefly highlighted.ResultsDermatologists have led the efforts to quantify and evaluate the global burden of skin disease, the burden of which is disproportionately shared by women. The dermatology community has also championed global efforts to eliminate skin-related neglected tropical diseases, such as scabies. Through national and international policy advocacy, dermatologists have pushed for more dermatologic therapies in the World Health Organization's Model List of Essential Medicines, helping to secure better care for patients with skin disease throughout the world. Since 2020, the dermatology community has worked collaboratively in the fight against COVID-19, establishing a worldwide registry for cutaneous manifestations of SARS-CoV-2 and pursuing research that has allowed colleagues in the house of medicine to better understand this landmark disease.ConclusionThrough the study and promotion of global health, dermatologists have an important role in the house of medicine.