Ensuring universal access to old antibiotics: a critical but neglected priority

Leading international healthcare professionals, including the President and President-elect of BSAC have called for steps to ensure universal and equitable access to old antibiotics for all health economies and the adult and paediatric populations is given priority. In a commentary Ensuring universal access to old antibiotics: a critical but neglected priority published in Clinical Microbiology and Infection Pulcini et al outline the issues and offer the following 6 recommendations for future action:

  1. Define (through the WHO Essential Medicines List and/or an ad-hoc WHO working group) the set of ‘key access’ here is antibiotics for which there should be universal access.
  2. Access here could be defined as: ‘An adult or child are able to receive when clinically required the appropriate antibiotic for their clinical infection syndrome at an appropriate dose, duration, formulation, quality and price.’
  3. Monitor the current global availability of these key access antibiotics. This includes both use—through the WHO Surveillance on Antimicrobial Use programme—and supply through a survey of global generic antibiotic producers of these key access antibiotics, including the formulations and cost. Monitor shortages through a common centralized mechanism.
  4. Conduct an antibiotic access gap analysis between clinical need and appropriate medicine availability. This needs to include an assessment of this variation by region and age.
  5. Re-evaluate the pharmacokinetic/pharmacodynamic targets for these out-of-patent antibiotics in the context of the global variation in rates of resistance.
  6. Consider the potential roles and feasibility of a Global Antibiotic Access and Conservation Fund, initially with the objective of implementing the five actions mentioned above.

The commentary concludes by calling on international agencies and organizations such as WHO and the European Commission to consider taking the lead in developing a strategy for ensuring the sustainable production, registration, and availability of old antibiotics that may help address growing problems of drug resistance as well as addressing the serious shortage or complete lack of other antibiotics.