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WHO reinstates Amphotericin B and flucytosine on the Essential medicines List

August 08 2013

WHO reinstates Amphotericin B and flucytosine on the Essential medicines List

Following representation from the Cryptococcal Meningitis Action Group (CryptoMAG), the 19th Expert Committee on Selection and Use of Essential Medicines has placed intravenous amphotericin B and flucytosine and oral flucytosine on WHO Model List of Essential Medicines (EML) for both adults and children. In addition to improved survival of patients with cryptococcal meningitis, both drugs have other uses, such as disseminated histoplasmosis, invasive candidiasis and aspergillosis.   

The decision-making meeting was held in the WHO Headquarters in Geneva from 8 – 12 April 2013 and reviewed and updated the 17th WHO Model List of Essential Medicines and the 3rd list of WHO Essential Medicines for Children.

The CryptoMag group(see news) partly funded by GAFFI, met  prior to this to finalize the reviewer responses to a prior EML submission. The arguments were evidenced based, primarily on the definitive trial from Vietnam lead by Dr Jeremy Day (who trained in Manchester, showing that this combination yielded a 40% lower chance of death).

Commenting on this, GAFFI's President, Professor David Denning said; “The WHO’s enlightened decision opens the door to saving many thousands of lives weekly from this devastating fungal meningitis in AIDS. The challenge now is to translate this recommendation into local availability and actual treatment on the ground in every country.”

The WHO EML is advisory for countries, but tends to be followed, if the burden of disease for the relevant medication is high enough. Translation into country pharmacopeias will take time however, especially when the drugs are not even registered for use, which is a significant issue for flucytosine.

Links:

The WHO notification; Application to move Flucytosine to Essential Medicines list

Adult list:

Chlidren’s list: