The World Health Organization (WHO) has published the first ever list of antimicrobials marked as authorized only for use in humans .
This is a list of 21 antimicrobials , a risk management tool useful to protect the overuse and abuse of critical first-line drugs, which must therefore be protected from overuse in animal and plant health sectors.
Controlled use
The responsible and prudent use of antimicrobials must be improved in all sectors to preserve their public health benefits. In particular, medically important antimicrobials for human medicine must be preserved by reducing their use in non-human sectors.
The List of Medically Important Antimicrobials for Human Medicine – renamed the MIA (Medically Important Antimicrobials) List – is a risk management tool that can be used to support decision making and minimize the impact of antimicrobials in non-human sectors regarding antimicrobial resistance (AMR) in humans.
The MIA list was created to guide antimicrobial stewardship efforts at the international, national, and subnational (local, state, provincial) levels.
It integrates WHO's AWaRe (Access, Watch, Reserve) framework and Antibiotics Book which provide guidance on the appropriate use of essential antibiotics in human health.
The list
The MIA list classifies antimicrobial classes according to their importance for human medicine and according to the risk of antimicrobial resistance and potential implications for human health arising from their use in non-human sectors:
of fundamental importance (critically important),
very important (highly important)
important (important).
Antimicrobials authorized “for human use only” include:
plazomicin,
aminomethylcycline,
anti-pseudomonal penicillins with and without β-lactamase inhibitors,
carbapenems with or without inhibitors,
third and fourth generation cephalosporins with β-lactamase inhibitors,
sulfones,
as well as key drugs for the treatment of tuberculosis and other mycobacterial diseases.
The list was drawn up in close collaboration with the Food and Agriculture Organization ( FAO ), the United Nations Environment Program ( UNEP ) and the World Organization for Animal Health ( WOA ) as a joint effort to harmonize and align the relevant guidelines and lists developed by the four organizations.
WHO reports that further work is underway to harmonize its guidelines on the prudent use of antimicrobials with its list of antimicrobials and the Woah list of antimicrobial agents of veterinary importance.
The “non-human use” category
In addition to the existing classifications of “highly important antimicrobials” (HIA) and “important antimicrobials” (IA), the WHO now includes a “non-human use” classification.
This group was added to “ensure that all antimicrobials used in animals are reviewed as part of the standard assessment approach, so that they are not placed in a low priority category by default, without adequate assessment of the potential risk of antimicrobial resistance in humans". (Source: https://www.vet33.it/ )