ESSENTIAL DRUGS IN PRIMARY HEALTH CARE
Item
- Title
- ESSENTIAL DRUGS IN PRIMARY HEALTH CARE
- extracted text
-
RF_DR_14_SUDHA
REVIEW OF MORBIDITY A,ND MORTALITY PROFILE OF PONDICHERRY
&
REQUIREMENT OF ESSENTIAL DRUGS IN PRIMARY HEALTH CENTRE
Paper to be presented
by
Pro f.P.Rajaram,
Di rec tor-Professor
Head oPtitre Dept.of OBGY &
Dean
31PM ER,
Pondicherry-6
at
Regional Workshop on
"Essential Drugs in Primary
(Bangalore,
27
Health Care in India
& 28 th Dune 1990)
M
•' !
that in the existing system political will and beaurocratic
machinery only can implement laws strictly if they want to.
This will help the clinician practice essential drugs concept
to bring down mortality and morbidity.
The problem of high mortality and morbidity amongst
mothers and children are vital for us to tackle in order to
break this vicious cycle.
it is necessary to
Therefore,
draw up a contingency plan to identify
the causes of mortality
and morbidity in the population and take preventive measures.
The lack of epidemiological data on Perinatal morbidity
for example that cover a region if not a
keenly
felt.
nation has been
The non-representative hospital data proved
ineffective in dealing with diseases.
Pondicherry occupies a unique status on the Indian
health map.
It is a
centrally administered Union Territory
with huge amounts of money pumped in for a population of
0.8 million. A'.verage amount spent on per capita in Pondicherry
is fa.125/- compared to fa.23/- in the rest of India.
If you
look at the Annual Report of Pondicherry Health Services,
it
is obvious that for ika some reason or the other chapter on
mortality and morbidity is mission.
This shows
the importance
given by Demographers and Administrators to mortality and
morbidity studies.
However,
in 1909 statistics a
glance at
item 1 5 on vital statistics the following is printed.
3
TABLE - 1 :
Vital
Statistics:
Po ndi cherrv
1. Birth Rate
©
2.
Death Rate
3.
Infant Morta1i ty .
22.2
Rest of India
2000 AD
31 .0
7.3
21 .0
9.0
12.0'
38.0
'> 1 06
<_ 60
I also failed to understand the implication of the
statistics given in the ileport on health care from the following
tables:
TABLE - IJi: PATIENTS TREATED IN MEDICAL
U. P.D.
INSTITUTES ('1989}
(Govt.Report).
INPATIENT
TOTA.L
h• PONDICHERRY:
1.
Institu te
9,60,426
48,846
10,09,272
2.
Health Centres
7,38,071
3,118
7,41 ,1 89
9,83,020
1 , 075
9,84,095
Gran d T o ta 1:
20,67,556
3. Dispensaries
8. KA BAIKAL
PIAHE i
YA,NAM
0.
is beyond my imagination approx.
Insured persons & their famili^es:
10,00,000
5,1 0,01 7
3.5 million +
Sidha + Ayurveda.
Total population is - 0.8 million.
Patients - 3.5 million
4.
5
TABLE - :U;
Ai. Mobile Dental Unit:
Male :
- .867 : 698 : 1892
Female : Children
Tooth out
- 760
Filled in
etc.
- 671
Rotten
( Ca ri es)
etc.
-
B. Artificial Limbs (10),
2577
Calipers (34)
Others (83)
C. Food, water & Drug
analysis.
10,662 samples.
-
TABLE - Vh
A. Government Pharmacy Drugs
Supplied value.
P.-..43,21 ,1 95.80
The following tables illustrate the mortality and
Morbidity pattern of the region and are self e>planatory.
I
shall discuss its impact on health care later on.
TABLE -VU; CAUSES OF FIkTERNAL FlORTnL ITY 1980-88) TOTuL - 1 63_.
A. Direct Causes:
1 . Sepsis (67)
2. Haemorrhage (29)
3. Toxemia
(24)
4. Rupture uterus (13)
5. Amniotic fluid embolism(6)
B. Associated Cause (1 7)
Pondy (in'io)
India (in%)
41 .1
28.4
1 7.79
22.2
14.72
9.89
7.97
N.A>.
3.68
N.A.
1 0.42
26.1 5
4.29
7.35
1 . Anaemia
4
2. Cardiac
7
3. Hepatitis 6
C, Unrelated (7)
Asthma, Ca.cx.,etc.
6
TABLE -VUIzMATERNAiL MORTALITY (OIPHEf?)
A'.ge:
8
Less than 14 y e3 r s
8.
C.
20 - 29 yrs.
. .
32
More than 30 yrs,
. .
36
Parity!
Primies .
... 23
Multies
. .
50
Grand Multies
. .
14
Duration of Hospital Stay:
Less than 24 hrs.
..
40
2 - 4 day s.
. .
20
More than 6 days
..
26
Maternal deaths are preventable tragedies killing
more than half a million women every year arotnd the world.
Many of these deaths are inaccurately classified and many
others are not reported at all,
but now demographic technique
have clarified causes of maternal mortality and improved
estimates of rates/
7
HURBIlI TY
7'
2.
PATTERN IN JIPMER OpD;
System involved.
1984
No.
/’u Of
total
1 908
No.
% of
total
Infectious diseases
44343
30.08
44637
3 7.01
Gastrointestinal 4
dental,
1 51 53
1 3.35
22385
1 8.56
3.
Orthopaedics
1 0902
9.60
1 9 51 0
16.18
4.
Respiratory
6956
6.1 3
1 2950
1 0.73
5.
Ear and Mastoid
5042
4.44
6820
5.63
6.
Skin
48 54
4.31
4890
4.06
7.
Miscellaneous
2368
2. 08
3836
3.25
8.
Renal and Genito-urinary
21 63
1 .90
3053
3.25
9.
Cardiovascular «
Lymphatic
2224
1 .96
3890
3.25
Ophthalmology
2079
1 .83
3336
2.76
11 . Ha ematologic
2391
2.10
321 3
2.66
1 2. Psychiatric
1 558
1 .37
3200
2.65
229 2
1 0.
1 3.
Gynaeco logic
2.01
311 0
2.57
14. Malignancy
1 736
1 .52
2474
2.05
1 5. Pregnancy & ito
complications.
3242
2.85
2378
1 .97
’ 6»
Symptomatic
1 690
1 .48
2240
1 .85
1 7.
Injuries
1 07IJ
■"M .05-
1975
1.57
1 8.
Nutritions
1 401
1 .23
18 73
1 .57
19. Nervous system
1 043
0.92
1020
1 .49
051
0.79
1370
1 .13
280
0.24
665
0.58
90
0.079
1 53
0.126
20.
Endocrine & Metabolic
21 , Benign Neoplasm
22.
Poisoning
8
8
TnBLE-X;. MORBIDITY PATTERN IN R.H.C.,
Morbidity
JIPMER,
1 984
1 988
36%
30%
i)
U.R.I.
31 %
33%
i i)
L . K, I.
5%
5 ‘/o
1 2%
11 %
Helminthiasis
2%
2%
p.U.0.
7%
5%
Myalgia
1 0%
9%
Ana ernia
2%
4'/a
GI I
4%
5%
Genito-urinary disorders
(3.5%
0.4 %
T.B.
0.5%
0.6%
Injury
8%
5%
1 0%
11 %
Eye
3%
2%
ENT.
2%
1%
Dental
2%
2%
Miscellaneous (CVS & CNS,etc.)
1 %
3%
Respiratory Disease
Diarrhoea including dysentry
(Fever)
a Liver
Skin diseases (including scabies)
•
■
'
. .. 9 .
*
-
■
I.
%........ ■>.'
.. , •
’LK.
_
W 9
For Pondicherry
the morbidity pattern is shown in
It is a
huge task to make a comprehensive
doove tables.
list.
After going through we Pound that it is a shear
waste of time to elaborate the morbidity patterns as they
are not reflective of the area and therefore is not valid.
I will now 90 to the second part of my paper i.e,
"Require
ments of Essential Drugs in Primary Health Care."
The essential drugs are those which are the basic
minimum group of drugs that should be available at all times
in the designated centres i.e.
from Subcentre to eipex insti
obviously the choice of drugs depend on the morbidity
tution,
pattern.
The Union Territory of Pondicherry has 14 PHCs inclu
ding 3 Community Health Centres.
A qualitative evaluation
of the few of the Centres showed that 2 doctors,
LHUs and AiNFls
posted are in place and all essential drugs are available.
However,
Labour Rooms and Operation theatres are not functioning.
Ai study of the prescription in the Rural Health Centre
of DIPPIER (Ramanathapuram)
interns^5).
was carried out by one of our
The major factors that influences the prescrip
tion, are rationality of drug use,
availability of the drugs,
lastly the complaints.
expertise available,
the nature of the patient and
They are directly related to one
another.(Tab 1e XI).
...10.
10
TRBLE - XI .
RATIONALITY
EXPERTISE
<------------ ?
AVAILABILITY
PATIENT «—> COMPLIANT
The aims of the study was to collect and criti colly
analyse various prescriptions and estimate the extent of
drug misuse.
tained by
Medical
Record Section,
Drug Registers main
Pharmacy and prescription were studied for the
following diseases:
T»BLE - XII;
1 . Myalgia
2.
Peptic Ulcer Syndrome
3.
Anaemia
4.
Upper Respiratory Tract Infections
5.
Lower Respiratory Tract Infections
6.
Vomiting
7.
Aicute Gastro-enteritis
8.
Tuberculosis
9.
Leprosy
Majority of prescriptions are made by those who are
undergoing Internship and are mostly either not supervised or
inadequately guided.
The number of prescriptions given and the drugs given
are illustrated in the following tables at 3IPMER adopted PHC.
.. .11 .
11
TAGLE - XIII:
DISEASES & DRUGS.GIVEN
Illness
Drugs given
No .o f
prescription.
/□of
prescription
Myalgia
Aspirin
0 CT/FST
Liv.52
Calmpos e
Vit.C.
50
44
1 2
1 4
8
1 00%
88%
24%
28%
1 6%
Other Drugs: I 1TS/Cardinal each in 2 cases.
P ep tic
ulcer
Syndrome.
Tab.FITS
-
1
2
1
1
tds
tds
b.d.
O.D .
54%
1 4%
1 0%
1 2%
32
7
5
6
Other Drugs - Caimpose, OCT,
FST
Ana emia
FST
OCT
Deworming agent
Polybion Inj.
Inferon Inj.
50
38
4
6
1 1
1 00%
76%
8%
■
1 2%
22%
Vomi ting
In j .flelodopramide
T.St ernetil
B CT/ FST
5
45
1 0
1 0%
90%
20% .
Cough expectorant
E. N.Urops
T.Piriton
Syp.Phenergen
T. Aspiri n
Paracetamol
Fl.V.drops & Vitamin
Septran
Procaine penicillin
38
20
39
18
32
22
40
1 4
18
76%
40%
78%
36%
64% .
44% ■
8 0%
28%
36/0 •
-*
U.R.I.
...12.
-: 12 : -
Drugs used
Illness
prescription.
% of
.
prescription
L.R.I.
Cough Expectorant
T.Piriton
Syp.Phenergen
Paracetamol
Vi tami n s
Septra n
Procaine Penicillin
Oral Penicillin
Tetracy cline
Ampicillin
1 9
12
11
38
32
1 5
11
1 8
3
3
38%
24%
22%
76%
64%
30%
22%
36%
6%
6%
Acute Gastroenteriti s.
ORS Packets
Cap. Tetracy cline
T.Metronidazole
T. Fu ro xo n e
50
1 4
12
10
100%
28%
24%
20%
Tuberculosis '
(Total) 14
cases.
INH
INH
INH
INH
INH
7
1
2
3
1
50%
8%
13%
21%
8%
Leprosy
DOS alone
HOT
+ EMB
+ THIO
+ MIR
+ RHP + EHD
alone
44
25
CONCLUSIONS:
In order to arrive at the requirements of Essential
Drugs in Primary Health Care,
it is necessary
to revidw the
morbidity and mortality patterns but certainly not the
which it is being done.
way in
Unless a revamp of the whole system
is carried out it is difficult for us to develop strategies
to implement the concept of essential drugs.
...13.
13
REFERENCES;
1.
Ba 1asub ramanian, K.
Global Marketing of Pharmaceuticals!
Paper presented at Global
Prescription for Disaster:
Development and Environment Crisis - Has Man a
Penang, Malaysia,
2.
Islam,
N.
Prescriptions and Professionals.
Med.Assoc., 1 988,
3.
86!
Rational Drug use:
0.Indian
48-51.
World Health Organisation:
action Programme
Future?
5-9 April 1987.
National Drug Policy and
A Model Curriculum (draft).
85.6,
Geneva:
Drug
World Health Organisation,
1 985.
4.
Task
Force on Maternal Mortality and Morbidity:
of Health and Family Welfare,
5.
Subramanian,
S.
Govt.of India,
Personal Communication.
1 990.
----- oOo------
Ministry
Neu Delhi.
OIpMER Intern,
M IQ • 2-
REVIEV? OF MORBIDITY AND MORTALITY PROFILE OF_KERALA
AND
REQUIREMENTS
OF.
ESSENTIAL DRUGS IN PRIMARY HEALTH CARE
DR. Ko RAJAN,
Professor and ICDS Consultant,
Dept. of Community Medicine,
T.D. Medical ©ollege,
Alleppey, Kerala
and
SRIo E.N. GOVINDAN NAMPOOTHIRI,
Asst.Professor of Statistics,
Dept, of Community Medicine,
ToDo Medical College,
Alleppey, Kerala®
1,
.INTRODUCTION
lol. General
Kerala State came into existence on 1st
November 1956°
The location of the State is
at the southern tip of Indian Peninsula between
8° 17’ to 12° 47’ north latitude and 74° 52
*
77° 24
*
1.2.
to
east longitude.
Area and Population
The area of Kerala ie 38, 864 Sq.KM which
is 1.18 percent of the area of the Indian
Union.
The population of Kerala has been
growing rapidly in recent years.
During the
40 year period from 1901 to 1941, the population
of the State almost doubled from 63.96 lakhs
to 110.30 lakhs and it almost doubled again in
the next 30 years reaching 213.47 lakhs in
1971.
According to 1981 census, population
of Kerala is 254.5 lakhs and a recent estimate
(1990) shows that population at present is
296.7 lakhs.
Contd...2
*"2°"
1,3.
Unique features of the Population of Kerala
As already mentioned, the population of
Kerala is 254.5 lakhs (1981 census),
The sex
ratio of the State is 1032 females per
1000 males as per 1981 census as against 955
for India as a whole,
A peculiar feature of the
sex composition of the State is that in all the
Gensus period 1901-1981, females outnumbered
males, while opposite is
the other States,
the case with most of
The density of the population
of the State (655 per Sq.KM.) is the highest
among the States of India,
The death rate of
The
the State is lowest among Indian States.
expectation of life at birth of femal.es is higher
than that of males.
In this respect, Kerala is
different from India and other States and resembles
many of the advanced countries of the world.
The
level of general literacy is the highest among
Indian States and is double that of India.
The health status of a population can be
assessed by the prevailing
mortality and
mox'bidity pattern of the community.
It is expected
that an analysis of the mortality and morbidity
pattern prevailing in Kerala may help the health
administrators and planners to develop their
strategy, in order to attain the national goal
of "Health for all by 2000 AD" on the basis of
primary health cane approach.
2.1^ Mortality and Morbidity pattern.
Changes in the mortality and morbidity are
studied under the following heads (1) Mortality
profile (2) Morbidity profile.
Contd
5
Sol,,!. Mortality profile
Usual measures of mortality used to study
the earliei- and prevailing pattern of mortality
are:
(1)
Crude death rate
(2)
Infant mortality rate
(3)
Expectation of life at birth.
2.1.2. Availabilitj__of_data
The census estimates provide the mortality
rate for the decades.
These are used along with
SRS annual estimates ( sample registration system)
for the recent years.
2.1.3.
Crude death rate
The census estimates provide the data for the
various decades.
These estimates along with the
recent estimates(as given by sample registration
system) is presented in Table I.
TABLE_I
DEATH RATES IN KERALA
Rate per 1000
population
Period
Kerala
India
19U
38.7
47.2
1921
33.8
36.3
1931
29.1
31.2
1941
22.3
27.4
1951
1961
16.9
22.8
9.3
19.0
1971
1981
9.3
6.6
12.5
1986
6.2
11.9
1988
6.2
10.9
14.2
Contd..o4
The table reveals that the death rate has come
down to very low levels.
These rates are also
very low compared to India,
The death rate has
started their downward trend by the begining of
this century.
Initially, decline was slow, but
accelerated by fifties.
The present rate of
Kerala is well comparable as that of developed
countries.
2,1,4,
Rural Urban. Variation
There is not much rural urban differences in
death rate in Kerala compared to other States
of India & India as a whole ( see Table 2 )
T1HU8
II
g?gAI.._gggAK„yAgIATION IN CRUDE_ DEATH RATLIN
KERA1A
Rural
Period
Urban
___ Kerala
India_
Kerala
I960
7,1
13,7
6.5
7.9
1981
6.7
13.7
5,8
7.8
1982
6.6
13.1
6.6
7.4
1985
6.7
13.0
6.7
7,7
1984
6,2
13.8
7.3
8.6
1985
6,5
13.0
6.6
7.8
1986
6,0
12,2
6.9
7.6
India-
A noteworthy feature of mortality pattern of
Kerala is the lower mortality rates
in rural
areas.
2.1.5.Infant mortality rate
The infant mortality which st normally
accounts for heavy toll of life, has shown a
more steeper fall in comparison with general
mortality.( see Table 5)
Contd..o.5
TABLE III
INFANT MORTALITY RATE IN KERALA
Rate per 1000 live births
Period
India
Kerala
1911
242
204
1921
210
174
1951
175
178
1941
153
174
1951
120
16.1
1971
61
146
1981
37
110
1982
30
105
1983
33
105
1984
29
104
1985
32
95
1988
27
94
Kerala State has recorded
the lowest IMR of
27 per 1000 live births among all the States in
1988o
It is worthy to note that IMR in Kerala
is just less than | of the national average.,
2olo6, Expectation of life at_birth
The expectation of life at birth and at other
ages show the net effect of the differential
mortality of various age groupso
The value of
expectation of life at birth for Kerala is given
in Table 4f together with those of India for
comparison.
Oontd.o. 6
TABLE IV
EXPECTATION OF LIFE AT BIRTH IN .KERALA
Expectation of life at birth ( yrs)
_
Males
.
Females
—
Kerala
India
Kerala
India
1911
25.49
19 0 4
27,41
20.9
1921
29.54
26.9
32,>70
26,6
1931
33.19
32.1
35=00
31,4
1941
39.89
32.5
42.34
31.7
1951
46.17
41.9
50,00
40.6
56.2
46.4
60,00
44.7
1961
(1966)
(1966)
1971
60,57
50.9
61,16
50,00
1988
67.00
55,60
70.00
54.0
From the table it is evident that expectation
of life at birth has been rising in Kerala and
females have higher life expectancy than males ,
Higher life expectancy of females - a pattern of
highly economically advanced countries - is a
unique feature of Kerala,
of life of females
'Higher expectation
may be due to the fact that
females have a lower IMR than males, as against
a higher IMR for females for the other States
of India,
The sex ratio of Kerala also supports
the above argument.
Kerala is unique in sex
ratio5 1032 females per 1000 males; reflecting
a differential mortality improvement,
3,
MORTALITT
TREND
The picture that emerges from the above
analysis is that the mortality rates started
their jg downward trend much earlier in Kerala than
in the rest of India,
fact
It is a well recognised
that extend-of mortality is influenced by
Contd...;7
■7-
the environmental condition of the State and
Socio-economic condition of the population.
Also effect of mortality on the different age
group of the population varies as many of the
morbid conditions are selective with respect to
age.
The available evidence shows that there has
been steady and early decline in mortality rates
in Kerala.
The factors responsible for this
may be;
1.
High level of literacy
2,
High level of personal hygiene
Scattered nature of the houses
( may be responsible for the high standard
of environmental hygiene)
4.
Universal availability of health and medical
facility both in rural and urban areaso
5o
Control of Communicable diseases, may be
to a large extent responsible for the
early decline in mortality rate in Kerala.
egs Cholera, Plague, smallpox.
Also
sharp decline in deaths due to Malaria
due
Maataria due to impact of eradication
programme in the State.
Si40 MORBIDITY PATTERN
4o1o Availability of data and its limitations
Comprehensive and detailed informations on
morbidity and mortality in Kerala during the early
and present pees? period are not readily available.
However, morbidity and mortality statistics based
on hospital records are available from the publi
cations of Central Bureau of Health Intelligence,
Govt.of India.
The data reported by CBHI have
the limitation that they are based on hospital
statistics and may not be comparable due to
incomplete coverage during the period of reference.
Hence one may be cautious while interpreting
the results
Contd..,8
4.
2<> Morbidity and mortality pattern due_to Communicable
diseases;
Morbidity and mortality pattern for
selected Communicable Diseases in Kerala for
the period (1966-1907) is presented in Table® 5.
Malaria
The highest reported incidence rate (No.of
cases per 100,000 population) was reported for
Malaria during
the period 1983-85. There after
wards there is a small but steady downward trend
in the incidence of Malaria.
The death rate
(No.of deaths per 100,000 population) is very
negligible? however it shows a steady and declin
ing trend.
The clinical records reveal that
most of the cases of Malaria are imported cases
from neighbouring States.
Tuberculosis
A recent estimate reveals that 3.72 lakhs
persons are suffering from Tuberculosis in
Kerala, out of which 93000 are
cases.
sputum positive
Out of 14 districts in the State short
course chemotherapy is in operation ,
-Ol fidisIdLcts .
(pilot study)An upward trend in the prevalence
of Tuberculosis is observed during the period
under reference except for the period 1983-85
( See Table 5)
The death rate is declining
steadily during the reported period.
The rate
declined from 7.2 per 100,000 population during
1966-70 to 1.01 in 1987.
Cholera
During the period under report
largest
number of cases of Cholera was reported in the
period 1971-75.
Thereafter there is a steep
decline in the incidence.
The death rate of 0.45
during 1971-75 is the highest.
However the
overall picture is that death rate is in the
declining side:
?
*
Contd«.«9
MOBBIDIK AND MORTALITY BATE PER .100,000 POPULATION DUE TO SELECTED
COMMUNICABLE DISEASES IN KERALA
SI.
..
Name of the
————'
cases
deaths
(average)
(average)
p
.
L
s
r
i
1971-75
oases
(average)
o
deaths
(average)
d
■
1985-35
cases
deaths
(average)
(average)
•
cases
(average)
1987
deaths
(average)
lil—---- £_2j---------------------- -------------------------- Ul,------------______________ (6j_____ (7)_______________ ______________ {21__________ £101 -.....
Xo
Malaria
0.6
(123)
0.02
(3)
Nil
15
(3921)
0.005
(1)
13
(3772)
0.005
(1)
(774)
2.
Leprosy
124
(25526)
0.20
(42)
+
+
+
+
271
(76041)
Sil
3.
Tuberculosis
151
(31090)
7.2
(1477)
175
(39007)
1.91
(424)
166
(44504)
0.74(198)
208
(58367)
1.01
(285)
4.
Diphtheria
■8
(1718)
0.99
(203)
2
(488)
0.05
(11)
1
(357)
0.01
(2)
1
(270)
0.003
(1)
5.
Whopping Cough
18
(3765)
0.40
(83)
141
(31318)
0.06
(13)
43
(11409)
0.01
(2)
40
(11121)
0.01
(3)
6.
Tetanus
2.21
(455)
2
(391)
0.36
(79)
0.70
(183)
0.04
(12)
0.70
(184)
0.15
(42)
11
(2354)
Contd...<x»/o
10
(3)
(2)
(1) '
(4)
(5)
(9)
“
(10)
(6)
(7)
0.13
(35)
3
(775)
0.23
(65)
(8)
7.
Polio
2.0
(410)
0.16
(32)
0.70
(166)
0.05
(12)
1
(377)
8.
Measles
14
(2877)
0.14
(28)
125
(27701)
0.03
(6)
88
(23569)
0.003
(1)
154
(45181)
O.06
(16)
9.
Biteric Fever
73
(14962)
1.72
(354)
69
(15267)
0.21
(46)
136
(36403)
O.01
(5)
34
(9544)
*4
0
(10)
10.
Cholera
7
(1408)
0.33
(68)
109
(2428)
0.45
(101)
0.40
(80)
O.03
(7)
0.50
(131)
0.03
(7)
11.
Bysentry
204
(42112)
2.57
(530)
2064
(458140)
0.29
(64)
2414
(497369)
0.21
(44)
2637
(738467)
0.24
(68)
12.
Gastroenteritis
+
+
+
+
86
(23021)
‘ 0.68
(181)
200
(56086)
0.65
(181)
13.
Viral hepatitis
56
(11636)
1.42
(292)
96
(21417)
0.14
(31)
47
(12640)
0.04
(12)
54
(15130)
0-09
(25)
14.
Influenza
119
(24586)
0.33
(68)
1942
(43H26)
0.01
(2)
2062
(552595)
0.003
(1)
2899
(811848)
Nil
15.
STD
0.13
(26)
15
(3283)
0.01
(2)
44
(11854)
Nil
59
(16413)
Nil
Note: 1.
2.
12
(2505)
+ Data not available
Heported cases are shown within the brackets.
1/
-U”
Leprosy
The State has an estimated case load of
1.4 lakhs of Leprosy patientso
The estimated
prevalence rate is 5.8 per 1000 population which
is slightly higher than that of India (5.7/100,06§k
population).
The registered prevalence rate for
the State is 3 per 1000 population while for
India it is 4.9.
Out of 14 districts in the
State, 6 districts have prevalence rate less
than 5$ 7 districts have prevalence rate between
5 end 9 and only one district (Palghat) has
prevalence rate 10.
This means that the whole
State is moderately endemic area for Leprosy,,
Only one district viz. Alleppey for which prevalence
rate is 6.6
is under MDT since 1987-88.
The
data presented in the table reveal that morbidity
due to leprosy is showing
an upward trend while
the death rate due to leprosy is declining,
recording no death during 1987o
gilariasis
The largest single endemic tract of B.Malayi
infection is along the cost of central part of
Kerala stretching over an area of 1970 Sq.KM
covering Quilon, Alleppey, Ernakulam and
Trivandrum districts.
It is estimated that
population exposed to the risk is 4 million in
1970 and about 6.63 million people are exposed
to the risk of filariasis in the State at present.
During 1976, persons having clinical manifestation
is 1.81 lakhs in Kerala and no.of persons carrying
microfilaria in their blood is 2.03 lakhs.
Official reports of delimitation survey held
during 1955-62 recorded that in Kerala, Alleppey
District in the worst affected area (Mf rate
d
12.8%; Disease rate *=■ 11.77%).
The recent
surveys recorded a Microfilaria rate of 2.08%
during 1986 and rate has reduced to 1
62%
*
during
1988 for the State.
Contd..ia
About 2.83
million people axe at present
protected against Filariasis in the State.
Childhood Diseases
The incidence rate and death rate of both
Diptheria and Tetanus show a declining trend
daring the period of reference.
A high incidence
rate of 141/100,000 population is recorded for
Who'yping Cough during the period 1971-75; but
thereafter a steep decline is registered.
Incidence rate of Polio is very low but registered
a very small increase from 2 to 3 during the
periodo
Death rate due to Polio also shows a
more or less similar picture.,
Incidence rate of
Measles shows an increasing trend, but death
rate due to it records a downward trend.
Other Diseases
The incidence rate of Enteri^cfever shows,
an upward trend during 1966-85(increased from
73 to 136); but register
after.
(Rate is 34
a sharp decline there
during the year 1987).
The
death rate reveals a steady and declining trend
(Declined from 1.72 to 0.04).
The incidence of
Viral hapatitis record a fluctuating trend over
the period.
The
death rate due to Hepatitis
dropped from 1.42 to 0.09 during the period;
recording a declining trend.
The incidence rates
of Dysentery,Influenza and STD show fast and upward
trend whereas death rates due to above diseases
registered a downward trend during the period.
4.3« Morbidity and Mortality pattern due to non-communi
Unlike the data on Communicable diseases,
the informations on nonr-Communicable diseases are
not
readily available.
Other reliable sources
are sought to obtain the relevant information.
The data reported in this study are from the
following sources;
Contd...«13>
-ri(1)
P.G.K. Panikar and C.R.Soman, Health
Status of Kerala, Centre for Develop
ment Studies, Trivandrum.
(9)
Annual administration report (1989) analysis of 'ROME’ data - Dept.of
Community Medicine, T.D. Medical College,
Alleppey - 5.
(3)
(unpublished)
Annual administration report (1989)
Medical College Health Unit, Ambalapuzha,
Medical College, Alleppey.(unpublished)
Cardio-vascular diseases such as Hypertensive
heart diseases, Ischaemic heart diseases,
Cerebro vascular accidents etc. contribute 11.7%
of the total admissions in the Medical College
Hospital Trivandrum in 1978.
Cancer shows 12.9%
Accidents and injury 12.5%, Endocrine disorders
5.3%, Diseases of the nervous system 4.5%
Disease of the Genito-Urinary system 5.6% of the
total admission.
The percentage of death (25.2) due to Cardio-
vaacular diseases stand first
in the Medical
College Hospital,Trivandrum.
The share of cancer
to mortality is 17% of all deaths.
The deaths
due to Central nervous system is 6%, Accidents
and Poisoning contribute 12.3% of all deaths.
The data on Nutritional Status show that
percentage of persons with PEM is highest in
Kerala (26.8% of the population is deficient in
both protein and calorie ) Distribution of pre
school children based on Gomez classification
reveals that 4.8% of children in Kerala are
severely mal-nourished and 33.5% children modera
tely mal-nourished; giving a total of 38.3% for
the two groups put together. This percentage
figure is lower than in other States.
Contd.,..l/j
—1Z^—
Morbidity pattern as registered in medical
camps organised 'by Department of Community
Medicine, Medical College, Alleppey and
out patient register of Medical. College Health
Unit, Ajnbalapuzha , Alleppey (1909) is considered
nextXSee
TABLE VI
MORBIDITY PATTERN AS RECORDED IN THE MEDICAL
COLLEGE HEALTH UNIT, AMBALAPUZHA,
ALLEPPEY - 1989
(Nou-•Communicable diseases)
Name of the diseases
Medical Camps
Medical College
Heal tlx Unit
(%)_
i
20
Hypertension
i
—-
Cataract
i
1
1.
Anaemia
2«
3o
4©
Diabetes
i
Total
(3102)
—®Total(63645)
The Analysis reveals that anaemia is a
major health problems in the rural areas of
Kerala.,
The foregoing discussion e reveals that the
dominant disease groups are (1) diarrhoeal
disorders (2) Eilariasis(3) Leprosy (4) TB
(5) Enteric fever (6) Influenza (7) STD (8) Wdrm
infection (9) Cancer (10) Hypertension
(11) Nutritional deficiency diseases0
5o..MORBIDITY TREND
The mortality is showing "h downward trend
whereas morbidity is showing an upward trend in
Kerala
inspite of the fact that Kerala has a
wider network of health infrastructure.
Contd»J67
The reasons may be
(1)
The people are more health conscious and
therefore they go for prompt treatment
even for minor and negligible illness.
Henoe more cases are recorded®
(2)
The same disease may be occuring to the
same person in different times.
So each
time at the time of reporting, case is
recorded as a new one.
(3)
Duo to the high price of the essential drugs
x
patient may not follow the full course of
the
drug.
So naturally we can expect
repeated attack of the same disease.
This
is again reported and treated with another
costly drug and again discontinued by the
patient due to his economic backwardness.
This is again recorded as a now one.
Also by prescribing and introducing a set
of lowcost
essential drugs,this vicious
circle can be broken.
(4)
Detection of more hidden cases from the
community by intensive activities of the
health workers.
(5)
(The high morbidity rate may be due the fact
of treating the symptoms while neglecting
the underlying causes0
6.
REQUIREMENTS OP ESSENTIA! DRUGS IN PRIMARY
HBAXTH
OARjB_
The main problem in making the essential drugs
available in the Primary Health Oentres in ths
limited financial allocation. The total budget
provision for drugs for a primary health centre in
uouolly one fifth of the actual need. Naturally,
there will be a gap between supply and demand of
drugrj in the Primary Jloolth Contras,
Oontd...,/(a
-Ko
to
overcome the situation of short supply of
drugs, -the doctor incharge of the Primary Health
centres should be trained to prepare the indent in
such a manner that it bridges the gap between supply
Importance should be given to cheap,
and demand.
and primary drugs based on the prevailing morbidity
pattern of the
local
*
Costly drugs should be
area.
relegated to the background.
Analgesics, antipyretics which are essential for
distribution in immunization carnps should be availa
ble through-out the year.
Anti helminthics,
haematinics, vitamins, anti-diarrhoeals, antiflatulants, antacids, antibiotic creams; simple anti-biotics
are the drugs essential for primary health care.
Drugs alone will not solve the problem if
repeated attacks of the same illness occur in the
community.
Therefore, equal importance should be given
for the distribution of drugs and organisation of
health education campaign to give basic knowledge
about the prevention of illness to the people.
<o ■ 1
jklST
OF ESSENTIAL DRUGS FOR
PRIMARYI
HEALTH
CARE
Essential drugs for the Anganwadi
1.
VitoA.Solution
2.
Iron and Folic Acid Tablets
3.
0 R S Packet
4.
Chloroquin tablet
5.
Paracetamol tablet
6.
Mebendazole tablet
7.
Chlorpheneramine tablet
8.
Gentian Violet granules
9.
Terramycin eye ointment
10.
Benzyl Benzoate emulsion
11.
Merctirochrome powder
Contdoo... 17
“ r/ “•
II
Centre
•
A» Drugs suggested for the Arganwadi
Bo Additional drugs,
lo Aspirin
2o Metoclopramide
3.
Contraceptive pills
4» Tablets and injections of methergine
III.Eagontial drugs for the Primary Health Centre
Ao Drugs listed for Sub Centre
Bo Additional drugs.
1.
Amoxycillin
2,1
Doxycycline
3o Chloramphenicol
4.
Penicillin (Procaine & Benzathine)
5 o Digoxin
6O Isosorbide dinitrate
7.
Phenobarbitone
8O Promethazine syrup
9o Glybenclamide tablets
10o Furazolidine
llo Metronidazole
12o Theophylline
13o Aluminium hydroxide
14o Chlorpromazine
15® BoComplex
16o Diazepam
17 o Antitubercular
*
drugs
180 .Anti-leprosy drugs
19» Diethyl-caJf&amazine
20 o I’rimaquin
21o Cotrimoxazol
22O Predhisolone
23® Atropine 10 eye drops
24o Homptropine 20 ayp dropfi
?r'„ Pi io-nrqi'l no
t,<!n
»'U, ll.vdri.oo.iU: LnOha eye 0 in. I lueti t;
•'/;< Aii jj.i 'nieil;rs von,.,-,
il.ydt’t'Ob.lij vn liiinzlde
Cento.....jf.
— IS
—
294
Tincture Iodine
30.
Whitfields ointment
31®
Xylocaine 4%, 2% and Jelly
32.
Injo Aminophylline
33o
Injo Adrenaline
34.
Inj. Demathasone
35®
Inj. Chlorpheninamine maleate
36.
I.V® fluids (Ringer lactate, 5% detrose, 5% dextrose
37o
Inj.normal saline
38o
Inj,atropine
39.
Inj.potassium chloride
40o
Injosodium bicarbonate
41o
42.
Injofrusemide
Inj.morphine^pethidine
43o
Inj.diazepam
saline)
44,1
Inj.oxytocin
45.
Inj.Paracetamol .
46. Ohlorhexidine solution
47. Vaccines, DPT, OPV, Measles, BOG, IT, DT and
rabies, anti cholera, anti typhoid.
Anti
The health status of any community can be
assessed by the prevailing morbidity and mortality
status. So the analysis of morbidity and mortality
pattern will be very useful for the health planners,
especially in the context of our aim to attain the
Goal of "Health for all by 2000 AD" on the basis of
Primary Health Care approach. Usual indices vis,,
Crude Death Rate, Infant Mortality Rate and Expeotartion of life at Birth are used to study the mortality
pattern of Kerala. The Death Rate has come down to
Very low level in Kerala and it is even comparable to
that of other well developed nations. No appreciable
rural urban differences in mortality rate exist in
Kerala. The lowest Infant Mortality Rate is recorded
in Kerala amongst the other States in India.
Oontd.9,*«|(|
- iq
Expectation of life at birth has been rising in
Kerala and females have a higher life expectancy
- a pattern existing in economically well
advanced countries - is a unique feature of Kerala,
The
analysis reveals that mortality rates started
their downward trend in Kerala much earlier than
that of rest of India,
Analysis ©f Morbidity
pattern indicate that morbidity rate (due to
Communicable and non-Communicable diseases) is
showing an upward trend wheras death rate due to
these diseases register a downward trend during
recent years.
The following communicable and non-communicable
diseases are prevalent in rural areas of Kerala for
which elementary drugs are necessary in the Primary
Health Centres and Sub Centres,
Adequate inservice
training should be given to the medical and para
medical staff working in these health institutions
along with the supply of the drugs.
Malaria, leprosy, Tuberculosis, Measles,
Enteric fever, Dysentry, Gastro-enteritis, Influenza
Anaemia, Helminthiasis, Scabies, Diphtheria,
Whooping cough, Tetanus, Bronchitis, Asthma, Urinary
infection, Rheumatic fever, Hypertension are the
common disease prevalent in the area,
Supply of drugs for the Anganwadi, Sub centre and
Primary Health Centre should be based on the preva
lence of the above diseases,
A suitable mechanism
has to be developed for the continuous supply of
these drugs to the District Stores for its final
delivery to the Primary Health Centres and Sub Centres,
ACKNOWLEDGEMENT
We are deeply indebted to
Dr»Saramma Joseph, Principals,
T»DoMedical
College Alleppey for her guidance,
supervision and permission to present
this paper0
Vie acknowledge with thanks for
the service of all members of staff
especially to SmtoK.K<,Bajamma, U<,D<>Typist
and SrioToRoBajagopalan Nayar, Artist cum
Photographer of this department for
their sincere work at very short notice
without which the paper would not have
been completed in timeo
OFEROCES
lo
Government of India, Health Statistics of
India (1966-70), CBHI, DGHS, New Delhi (1975)
2„
Government of India, Health. Statistics of India
(1971-75), CBHI,DGHS, New Delhi (1976)
3o
Government of India? Pocket Book of Health
■
r c'
.... H;7:. OHMGM
New Delhi (1978),
4»
Government of India? Health Statj.stics of India
1981 CBHI, DGHS, New Delhi (1982),
5»
Government of India, Docket Book of Health
..
■■
197t; OIHI,DGHS,New Delhi
(1979)
6c,
Government of India? Health Statistics of India
1984 CBHI,DGHS, New Delhi (1984)
7o
Government of India? Health Statistics of India
1985? CBHI,DGHS, New Delhi(1985)»
8O
Government of India? Health Information of India
1286, CBHI,DGHS, New Delhi ( 1988)
9o
Government of India, Health Information India...
1987, CBHI, DGHS, New Delhi (1988)
10o
Government of Kerala, Health Profile Kerala
1990 -- Deptoof Health and Family Welfare,Trivandrum
Kerala (1990),
11,
Mahendra Dutta & Bhaain VIP® Communicable Diseases,
Pattern of Morbidity and Mortality in Iflndia,
CBHI, DGHS, New Delhi (1979)
12<>
Kurup, R.S, et®al, Fact Book on Population and
Family Planning, DRC, Bureau of Economics and
Statistics, Trivandrum (1975)«
- SA-
13®
Sarama S.P® et®al, 'Current estimates of
Filariasis problem in India” The Journal
of Communicable Diseases Vol. 9, No ® 2(1977)
14®
Panikar, P.G.K. and Soman, C.R.Health Status
of Kerala, Centre fox’ Development Studies,
Trivandrumo
15®
Dept®of Community Medicine,
"Annual Administra
tion Report, analysis of ROME data 1989 ,
T.DoMedical College Alleppey, Kerala
<0 unpublished).
16o
Medical. College Health Unit "Annual Administration
Report, Ambalapuzha"
(Unpublished^ T®D®Medical
College, Alleppey - 1989 (Unpublished)
17®
Government of India, National Leprosy Eradication
Programme in India 1987 - Facts and Figures on
Leprosy,
Leprosy division, DGHS, Ministry of Health
and Family Welfare, New Delhi ( 1987)
18s
Dept.of Community Medicine, Proposal for permanent
Filaria Research Unit of ICMR at T.D.Medical
College, Alleppey,
T.D. Medical College, Alleppey
1986 ( unpublished)®
"ESSENTIAL
DRUGS IN PRIMARY HEALTH CARE
IN INDIA"
BY:
DR. S.B. DIXIT,
M.D
PROFESSOR AND HEAD
DEPARTMENT OF PREVENTIVE AND SOCIAL MEDICINE,
GOA MEDICAL COLLEGE,
BAMBOLIM P.O. SANTA CRUX,
GOA 403005, •
(0) 3668/5440.
DR, MRS. MACULA DIXIT, M.D.
C.M.O.
CENTRAL HOSPITAL,
T1SCA USGAON,
GOA.
ESSENTIAL DRUGS, IN PRIMARY HEALTH CARE
- IN INDIA. "
India, is: committed to attend the goal of Health for all by the year
2000 jW through the universal provision of Primary Health care services,,
Provision of essential drugs, is. considered to be an important element
amongst the 7 elements of Primary Health cars.
In India Primary Health care is provided by many workers, example,
community Health worker(villago Health guide), Anganwadi warkor, Dais,
Multipurpose health workers, traditional birth attendants/trained birth
attendants. Most of them are provided with a medicine kit for treatment
of minor ailments.
The national health policy provides the universal comprehensive
Kro-ncJi'v
Primary health care services relevant to th® actuarl needs and priorities:
of the country at a cost which people can afford, insuring tbht the plan
ning and implementation of the various health programmes is through the
organised involvement and participation of the community adequately
utilising the services being rendered by voluntary organisation active
in health sectors.
All governments to formulate national imjiikh Etyjifcsri policies, stra
tegies and plans of action to launch and support Primary health care as
a part of national health system,provide community health care, attend
to vulnerable’ and underserved groups.'
Primary health care strategy calls for a sustained efforts to stimu
late and organise the community to give itself a health system
econo-
mically, socio-culturally and techndioiijlcally appropriate t© meet the
specific health needs.
Despite the fact.that a high.proportion of the health budget of the
countries in the region is spent on drugs, the rural population often has.
no assess to the life saving and essential drugs. Scarce national resources
are often wasted on less essential'drugs which are marketed in the develop
ing countries whore the drugs consumption pattern often docs not reflect
the real health needs. In countries where health for all has received
endorsement as. policy at the highest offic/ial level,at least 5% of C.1P
is spent on health. km A reasonable percentage is devoted to 1st level
contact .care including availability of atleast 20 essential drugs within
one hour. walk.
Comprehensive drug policy can bring about a radical change in the
present situation by streamlining every aspect of the pharmaceutical end
system. This, would ensure the availability of essential drugs of
high
quality,
safbpy and efficacy at reasonable prices and their proper
utilisation by health person. VJHO had' an important role of technical co
operation in the formulation'of drug policy. There is also the need for
the proper selection of traditional medicines of established efficacy for
use in Primary health care, linked with the expanded use of traditional
medicine is the need for Organised training programme for traditional.
practitioners in the preventive■and promotivc aspect of primary health Care
The "essential drug monitor" is a newspaper-letter produced and '
distributed by the WHO action programme on essential drugs and vaccines,
Since the action programme was launched in 1981 more than 100 countries '
have/ cither drawn up essential dnhg list or started projects in support
of Primary health care providing reliable essential drugs and vaccines
which, ■
1.
meets pco/ples common health needs
2.
has significant therapeutic value. ■
3.
are acceptably safe .
4.
offer satisfactory value for money.
A- conference of experts on the national use of drugs was convcilod
by WHO in Nairobi(kenya)
from 25th to 29th November, 1985.
The dxperts supported the need for government to adopt a national
drug policy based on the essential drugs concept as a part of their
national health policy for attaining the goal of health for all by year
2000. The aim of a national drug policy Dr. Mahler said.would be to ensure
C&nSCant
'
the/a-vailability of efifiicacdous drugs of acceptable■quality and safety t®
all in need of-them, such drugs must be really required for maintaining
peoples health.and combating disease. It was emphasised that good manufa
cturing practices and quality control were integral parts of’drug regula
tion.
It was generally felt that pharmaceutical industry has major-rcspon- ■
sibility for compling with- established norms and avoiding different stand
ards in different countries. WHO agreed to issue mod&l data sheets and
formularies for those drugs included in the WHO model list of essential
drugs for government use,
,
The experts recognised that for making drug use more rational, app-
ropratc national legislation was required, the main responsibilities of
all those concerned inlmaking drug use. move rational lies .with the govern
ment, pharmaceutical industry, prescribers, medical colleges, teaching
institutions and professional organisations, the public, patient and
consumer groups and the-.mass madia.
3
It is estimated that there are between 1,00,000 to 2,00,000 drug
products- available today in the world market, the WHO has determined that
fewer than 250 of these drugs are essential, to treat most of the illnesses
experienced by majority of world’s population.
It is useful to have available standard list of drugs'and equipment,
reduced to the minimum that take into account the epidemiological situation
as
all as the resourdes available.
The problems involved in providing essential drugs presents an almsst
overwhelming challenge to all countries. Drug selection is difficult main
ly because of the variety of drugs from which to choose, drug procurement
problems includd the’number of possible drug Kpnxd sources, the complexity •
of estimating needs and the difficulties of arranging payment for the drugs
that arc needed. Drug distribution required the carefully planned inter
action of transportation, storage and management system. Appropriate drug
use relies on training and public education. ihese problems'are magnified
in developing countries where infrastructure and.resourdes; are often s
scarce. The policy decision related to essential drugs are made at several
levels the strategies may be at National, community and individual level.
The section on national strategies discusses drug selection, supplies,
costs, distribution system and regulation. The section on communtiy stra
tegics covers, needs, assessment, storage, stock control and training and
finally consumer education and patient information are discussed under
individual strategics.,
DRUG SELECTION.
The drug selection process is made difficult by the vast number of..
available prescription and'non-prescription system items. All of these/
.medicines are created from approximately 250 activd substances which are
the chemicals in drugs responsible for the therapeutic 'dffect. It has
been estimated that there arc on the average 70 different brand names for
each drugmoalelecL Uday-.
’
Prepar/ation with no known therapeutic value include many vitamins,
tonics and cough preparations which are available without prescription.
In 1982 a panel of exports has.compiled a list of 230 drugs, and a model
list of 22 drugs for use in primary health care. More than SO countries
have developed national formularies or drug lists based on the WHO model
list of essential drugs. International non-proprictary generic names for
drugs are used'and combinetiion drugs are avoided unless they, meet an' im
portant specific therapeutic need.
-
4
-■
'
DRUG SUPPLIES
There is an increasing tendency to use drugs as the treatment of choice
for all kinds of disease as., a. result treatment other than drugs are too
often overlooked.
More developing countries relies on- import of large part^ of their
annual drug need^ to reduce the need for foreign exchange , some developing
countries have adopted policies’that facilitate local production of drugs.
There.policies include restrictions onjimporta of foroigg products, in
so .e countries local repackaging of imported bulk shipments.have been
instituted.
National drug production is also being encouraged through the increased
use of herbs. The national corporation of herbal' medicine in the peoples
Lc<Jei on
republic of China reduces 5,700 types of medicinal plants and 7,00,000 tons
of herbs annually. In Philippines
mjcxe
whcreqthorbilist have long provided
rural medical care the ministry of health is
encouraging research on medi
cinal plants. Factories are being setup to process herbs and the national
formulary lists more than 30, medicinal, plants. Quality assurance is critical
to all drug programmes. WHO, has instituted a certification. scheme that pro
vides 'importing countries with information, on whether or not a- product has
cj m&nQjfic.ldr'e ■
been approved.use cn iJi
REDUCING■COST
In any country cost is a central issue in drug selection procurement
and availability while the annual per capita consumption of pharmaceuticals
irideveloping countries is small in'comparison to that of developed countries
•I
.fesM-'-ti ve
(US dollars 16 and US dollars 50) drug purchases can sometime account for
nearly half of the health budget. Several stops may be taken to cut this
Cost.
- limited formulary can’bring about, significant saving.in'the cost of
procurement, handling, stocking and training...- Bulk purchases
'.. '•< ....
.
..
.....
- competativo biddings. UNICEF has taken advantage of both bulk purchase
and competativo bidding to save money by purchasing drugs- for over 100
countries.
- uce of generic - ordering drugs by their generic name
- dosage forms - in general tablets or capsules arc the least expensive
dosage form. .
.
I
-
5 ' - •
Distribution System
Most countries have a private market system,' often practitioners
also dispense.. Many/ countries also dispense' free or^suhsidised drugs
through the national health system. In Philippines, Mozambique and
Haiti the government has also attempted to extend drug access to
iaolatelcommunities by establishing rural pharmacies that sell essential
drugs at'small profit.
Co-operatives are currently operating in Thailand and- experimen
tal trial in Philippines are financed as revolving funds started with
money raised by the-community. Transporting drugs is a serious problem,
long delays or exposure to heat may causd drugs to expire, loss and
cf
theft are also serious concerns. Some creative attempts to solve these
problems under Kenya’s new management system of drug supplies which
started in 1981, sealed prepackaged’ s ration kits of essential drugs
.are sent out to health posts.- The kits uf sxxoitiRi dtaagx
xxh
contain 39 items for health centres and 31 items for dispensaries.
Tanzania has also started using a similar system.
Regulation
In general over the counter ^OTC) drugs decrease medical staff
requirements, decrease the cost of'Uandling and managing drugs through .
public health system and increase the availability of medicine in
isolated areas. Disadvantage is;-the misuse by consumer and may delay
some people from urgently needed medical attention. Cuba and Bangla
desh have severly limited OTC preparation.
Community Stategies
Needs assessment:- can be based on the pattern of previous use, or—on
epidemiological data on diseaser incidence and prevalence.'Estimated
basis jon use are less helpful if • the previous use record reflects
shortages of supplies or if population is changing quickly dur to
influx or outflow. A micro-computer model for planning drug require
ment has. been developed that can calculate heeds based on both and
this has been tested,in Indonesia and Morocco.
Drug Storage:- Heat .and moisture especially in tropical countries can
cause drugs to deteriorate, this can be reduced by choosing a shady
breezy location and by providing adequate ventilation.•Refrigeration
is necessary to maintain a' cold chain for vaccine. All drugs should
be labelled with at least their classification name, dosage form,
strength and.date of expiry.
..6/-
:
-
6
-
Stock Control:- Procedured include
•
- checking system against-order records for damage and expiry date.
- arrange drugs alphabetically, by therapeutic category, clinical
'indication, frequency of use or a combination of these methods,.
Estimating Drug Needs;• Morbidity based needs estimates are calculated by first listing
the expected symptoms, number of cases, and proposed treatment,, The
expected'number of cases can be estimated by using survey data. Course
of treatment information from the national formulary is then added to
the above estimates of number of cases to give estimated total drug
requirements. An initial order increase of 25% will cover the contigencies for wastage and to provide for reserve if need -increases. Re
cord keeping and timely re-ordering will facilitate the supplies.
Training and continuing education for both prescribers and dis
pensers are important in any essential drug system. PHC workers who
prescribe medicines needs to be trained in the indications for an
safe prescription-of the selected drugs. WHO has drafted drug infor
mation sheets for a whole list of essential drugs that can be adopted
by each country. Each sheet list the drug name, indications, recommen
ded dosages, precautions, adverse effects, interactions and directions
for storage.
Individual Strategies
Consumer education and patient information are tcro important ways to
infuse appropriate drug use. Underuse and overuse of drug is a problem,
common belief is that purchased medicine is.better than what can be
prepared at home. These attitudes can result in waste of resources
and can contribute to' problems like drug resistance. Social marketing'
is one useful approach that examine such community attitudes and has
been used in several countries to promote ORT and contraceptive use. . •
Patient information
If patients understands what kipd of mddicines they are taking and why
and importance of finishing the full course of treatment, compliance
can/ be increased. All prescriptions and OTC preparations should he
labelled with information that includes the drug name, form, strength,
proper, dosage and any warning, contraindications or special instruc
tion for use. Drug information material have been developed for patient
who cannot read. They use pictures to represent the mx amount of modi-.
cine to be taken at different time of the day, in.some cases these
material also represnnts the illness for wh/ich :the medicine is being
used. Pakistan has recently decided that package inserts are to be
-
7
-
printed in the national language Urdu and English. In Kenya the
government
is supporting .a programme to improve the supply of es
sential drugs to church related rural health-institutions and to
train the staff of these bodies in the rational use of the drugs.
All government dispensaries- and health centres in the country receive
standard kadi kits of essential drug.
■
■ Essential drugs are vital to primary health care. The provision
of these drugs is a complex challenge that needs to: be met at the
national, community and individual levels while tho-establishment of
the.drug formulary and standardized treatment schedule is best done
as a national policy. There.are important drug issues that need to
be adressed at other levels by health workers and programme ipanagers
as well. Needs assessment, storage, stock control, training and public
education are all necessary to make the best possible use of drags tin t
are available. National drug policy can' only .succedd when the community
and individual strategies are in place.
Guidelines for f ormuln;hixig.dram..policies.
Its objective should be-to strengthen the national capabilities of
developing countries in the proper selection, production, supply,
distribution and uud use of drugs to-meet their health needs. The
programme should assess-the .availabilikjt resources such aw manpower,
raw material, finance, technical skill and technology and aim at creating^in infrastructure for an efficient drug supply system and the
achievement of self sufficiency in essential drugs and vaccine. Role
of public sector is important in insuring a constant supply of depend
able quality.
In India main health problems are of communicable diseases, mal-
nuttition, environmental sanitation, population .explosion, medico
social problems and medical care problem. Most of these are preventable
and curable. Although drug constitute only a. small part of health care
yet vital and essential. There is a need to prepare a list of essential
drugs appropriate to local needs, these drugs should be made available
with the health guide, ANW, MPW and PNC.
In order- to'have the optimum utilization of the essential drugs
the government may bring out a model list of drag for different regions/
state depending on the morbidity pattern^ the epidemiological situation
and the budgetary allocation.
I am furnishing herewith the list of essential drag for
j. Tire kit of VHG/ANW
and
Essential drug® at the subcentre level on annexuro 1
2.
3.
Essential drugs at PH6 on annexuro 2
List of essential, drugs based on WHO recommendations on annexure 3
,
4)
s
■
Essential drugs to be used in aciiite respiratory infection-.
annexure 4
.• <
In Goa we nave carried out 2 studies one on the morbiaity
profile-.or rural . children and the other study was on moroidity
profile of an urban sGuiemen of Goa. In both these studies the
first 5 causes of morbidity are:-
1)
Respiratory infection
2)
infective & Parasitic diseases
’5) Gastro-intestinal disorders
4)
Malnutrition
5)
Skin infection
Since ARI constitute fthe major cause of morbidity among
under five, recommended treatment schedule is also included for
the use of.primary health. care workers, in Annexure
IV. They
.should be trained in the . aiagnosis and. management of ARI
It is also recommended that the quantity of the drugs should
depend- on the seasonal trend- and sickness load, regular monitoring
and evaluation is nedded in order to ensure availability of drugs.
Judicious use of drugs also should be. done.
c\
References
Beverley & Dullen' :
Proper use of the right drug, a complex
task.
World Health Forum 1988.
■
WHO: ,
Vol. 9, No. 2.
Report of the conference of experts Nairobi
1985 “ The rational use of drugs'1
WHO:
The use of essential drugs.
IRS. No.722
1985
DIRECTIONS/5.2. 1985: Programme for appropriate technology in
.health.
reprinted in India by UNICEF 1988.
ARI hews:
Issue No.15 AHRTAG London August 1987.
WHO Chronicle:
Rational use of drugs
40 (1)
WHO Chronicle:
:
5-5 (1986)
Exchange on experience on Primary Health
care.
58(4);
187-189 (1984)
WHO
The world drug situation
WHO
' Guidlines for developing drug polices 1983
Sisastiieird:
National drug policy
jctober 1987
WHO
Essential drug Monitor
No I 6 1988
1988.
ANNEXURE - 1
WORLD HEALTH ORGANISATION
MODEL LIST OF DRUGS
FOR PRIMARY HEALTH CARE
The following list of 22 drugs was selected by WHO from the full
model list of essential drugs as those which might be appropriate for
administration by a tradiational healer or community health worker..
In practice this list needs to be modified for each country to reflect
the disease patterns, existing medical coverage, and level of trainings
Drug
To Treat
acetylsalicylic acid
pain, fever, inflamation
activated charcoal
swallowed poisons
antacid
indigestion, heartburn, and stomach ulcers
antihemcrrhoidql drug
hemorrhoids or piles
atropine
muscle spasms
benzoic acid+salicylic acid
fungal infections
benzyl benzoate
scabies and lice
calamine lotion
skin irritation
chlorhexidine solution
skin infections
chloroquine
malaria
chlorphenamine
allergiv reactions
ephedrine
asthma
ergometrine
postpartum hemorrhage
ioding
iodine deficiency, infections
ipecacuanha
swallowed poisons(causes vomiting)
iron/folic acid
anemia
lindane
scabies and lice.
mebendazole
parasitic diseases
oral rehydration salts(OkS)
diarrheal dehydration
paracetmol
pain and fever
piperazine
ascaris and pinworm
tetracycline eye ointment
conjunctivitis.
ANNEXURE - 2
ESSENTIAL DRUGS SUGGESTED FOR THE KIT OF C.H. V./V.H. G.
1.
ORS packets
2.
Chloroquine tablets
3.
paracetamol tablets
fejrhRH 4O Mebendazole tablet
5o Vitamin A solution
Go Iron and folic acid tablet
7. Mercurochrome powder
8.
Chlorpheniramine maleate tablet
9.
Gentian violet granules
10.
Boraspitit ear drops
11o Acriflavine powder
12.
Terramycin eye ointment
13.
Benzyl Benzoate emulsion
14.
Cotrimoxazole
15.
Oxyphemonium bromide tablet
16o
Chlorine Tablets (For chlorination of water)
17.
Zinc sulphate eye drops 0.25%
EiiXential drugs at the sub-centre will be the same as above plus
the drugs mentioned below;-
1.
Aspirin
2.
Metoclopramide X Bills
3.
Contraceptive - Pij.ls
4.
Tablet and Injection Methergin
5.
Activated charcoal.
ANNEXURE _ 3
V
ESSENTIAL DRUGS AT THE PRIMARY HEALTH CENTRES
As Drugs listed for sub-centrs
Bo Addition'll Drugs.
1.
Amoxycillin
2,
Doxycycline
3.
Chloramphenicol
4.
Penicillin (Procaine & Benzathine)
5.
Digoxin
6.
Propranolol
7® Dihydrallazine
8. I so sorbide dinitr&te
9.
Phenobarbiton®
10.
Promethazine syrup
11.
Glybenclamide tablet
12.
Amitriptyline
15.
Furnzolidine
14.
Metronidazole
15.
Theophylline
16.
Alluminium hydroxide
17.
Chlorpromazine
18.
B. Complex
19.
Vitamin D
20.
Diazepam
21. Anti~tubercular drugs (available under NTCP)
22.
Anti Leprosy drugs (available under NLEP)
25.
Diethyl - carbamazine
24. Primaquin
25. Sulfadoxide hydrochlorade
26.
Cap Gynae T/P
27.
JDsoxsuprine hydrochloride
28.
Povidine Iodine vaginal pessary
29.
Tab. Prednisolone
30,
Atropine 1% eye drops
31. Homatropine 2% eye drops
33.
Pilocarpine 2?4 eye drops
33. Hydrocortisone eye ointments
34.
Hydrochlorothiazide
35. Antionake venom
36.
Chlorhexidine solution
37.
Tincture Iodine
38.
Whitfield’s ointment
39.
Xylocaine 4%, 2?» and Jelly
40.
Inj. Aminophylline
41.
Inj. Adrenaline
42.
Inj. Dexamethasone
43.
Inj. Chlorpheniramine Malaate
44.
I.V. Fluids (Ringer Lactate, 5% Dextrose, 5%0extrose salina)
45.
Inj. Normal salina
46.
Inj. Atropine
'
\
47. Inj. Potassium chloride
48.
Inj. Sodium Bicarbonate.
49.
Inj. Frusemide
'i
50.
Inj. Morphine/Pethidine
51.
Inj. Diazepam
I
52.
Inj. Oxytocics
53.
Vaccines - DPT, RKOPV, Measles, BCG, TT, DT and nntirabies
ANNSXURE - 4
Recommended treatment schedules
Cotrimoxazole:twice a day for five days
Amoxicillin:three times a day for five days
Age
less than 2
2-71 months one to four
*
months
(6-9kg) „
years(lO-19kg)
Dose
62.5mg
125mg
250mg
Tablets
(250mg)
quarter
half
1
Syrup
2.5ml
(125mg/5ml)
5ml
10ml
(1 adult tablet=80mg trimethoprim+400mg sulphametho' .
xazole
1 paediatric tablet=2Omg trimethoprim-s100mg sulphamethoxazole;
5ml syrup=40mg trimethoprim
*
,
200mg sulphamethoxazole)
i
Age
less than 2
2-11 months
one to four jtears
*
months
(6-9kg)
(10-19kg)
Tablets
Adult
quarter
half
1
Paediatric 1
2
3
Ampicillin:four times a.iday for five days
A
2^-11 months one to four
age
less than 2
(6-9kg)
years(10-19kg)
*
months
Dose
250mg
250mg
125mg
Note;for infants less than one month old, give half a ;
paediatric tablet,or1.25ml syrup.Cotrimoxazole should
not be given to infants who are prematuree or jaundiced
Tablets
(250mg)
procaine penicillin (intramuscular injection) once a
day for five days:
half
Syrup
2.5ml
(250mg/5ml)
1
■ 5ml
1
Syrup
2.5ml
5ml
7»5ml
Age
less than 2
*
months
2-11 months
(6-9kg)
one to four years
(10-19kg)
Dose
200,000units
400,000units
800,000units
5ml
:4
REVIEW OF MORBIDITY AND MORTALITY PROFILE OF TAMIL NADU AND
REQUIREMENTS OF ESSENTIAL DRUGS IN PRIMARY HBAIffi CARE
K.G. KAMAIA
**
A. PARTIIASARATHY-1'
TAI-HL NADU la rapidly trying to catch up KERAIA in bringing
down its IMR to tho
Health for all 2000 AD target level.
National
programmes like Universal Immunization Programme, Diarrhoeal Disease
Control Programme^ Vit. A
prophylaxis, Anaemia prophylaxis etc. have
already gained momentum over the last five years and have started
yielding
good results.
The -Jxend of morbidity now seems to be
from Respiratory Infection followed by Gastro enteritis and other
infections in that order'.
While' planning for the prioritization and
requirements of essential drugs in Primary Health Care, it is necessary
that we critically review tho morbidity and mortality pattern of the
given region with particular reference to their changing trends over
the proceeding ten years.
present such a
An attempt is made in this paper to
situational analysis to ensure a practical oriented
approach in the procurement and use of essential drugs in primary
Healih Care.
In any primary health care system, the morbidity and
mortality pattern of the priority group will eventually give us
tile ideal essential drugs
that are needed for primary health care.
This priority group are the children especially the newborns, infants
and the under 5
s,
*
pregnant and lactating mothers and the Geriatric
problems oriented old age population.
Let us therefore analyse the
mortality and morbidity pattern of this group.
Again the representative
samples of this group could be approached from the field based data
* Consultant Pediatrician & Asso. Prof, of Pediatrics
** Director & Professor of Pediatrics
Institute of Child
Health and Hospital
for Children,
Madras.
as ’Jail as the Institutional data.
In this communication, ’Hie
figures for -the entire state of Tamil Nadu and the figures obtained
from ihe Institute of Child Health, Madras are utilised and analysed.
Het ’is first critically review and analyse the figures obtainable
through the Civil and Sample Registration Systenvj (CSRS) of Tamil Nadu
State.
The total population of Tamil Nadu is 484
08
*
lakhs (1981) with
a HYP of 553.97 lakhs (1990) distributed in 25 revenue districts.
Each
revenue districts is further split into 2 or 5 health unit districts
for better delivery of the welfare schemes under Primary Health Care (PHC)
The DHO’s (District Health Officer) look after the PHC's apart from the
district and these health unit districts are grouped into 7 regions
under the guidance
and administrative control of the Regional Deputy
The system is working
Director of Public Health & Preventive Medicine.'
very well with good coordination.
In Tamil Nadu, the CRS is in vogue in all districts and the
SRS is conducted in selected rural and urban areas.
The efficiency
of births registration is 70-75% and that of Deaths registration is
60-65%
The following table gives the vital rates as per CRS & SRS
for the year 1981 to 1988.
TABLE
I
VITAL BATES AS PER CRS & SHS 1981 - 1988
IDAI'IIL NADU
CRS
SRS
YEAR
BR
DR
rm
BR
rm
DR
1981
18.94
5-98
55.22
28.0
11.8
91
1982
18.52
5.86
6.20
30.11
. 27.0
11.2
32.51
27.9
1.1.7
85
88'
29.86
28.0
10.8
78
28.47
24.7
9.5
81
1985
18.79
1984
17.98
1985
17
07
*
55
7
*
30
*
5
1986
17.26
5-54
28.51
25.8
9.5
80
1987
1988
17.17
16.^6
74
*
5
29.25
24.0
9-9
76
79
*
5
28.00
22t5
^2
14
8.9
rm
PROVISIONAL 1909
SRS:
BR
21.6
DR
69
’
3
’
You could, see from the above table as to how the SRS gives
more reliable information
than the CRS.
However it is gratifying to
note tlie decline in BR, DR. and H® to 22.5, 9.2 and 74 in 1988;
an
overall decline when compared to the 1931 figures.
The Medical Registration system (MRS) is being conducted in
54 selected primary health centres so as to identify the most probable
This is very essential for a reliable Mortality
cause of death..
For instance in the table given below, you could see
statistics.
the . distribution of infant deaths as different components.
II
TABLE
DISTRIBUTION OF P®. NMR, AND'PNMR
1984 - 1986
-
TAMIL NADU
1984
%
1985
%
1986
%
Early neonatal
42.7
54-5
45.2
55.6
45.5
57.0
Late Neonatal
13.6
Neonatal
56.3
71.90
56.4
69.7
57.1
71-55
Post neonatal
22.0
23.10
24.9
30.63
22.7
28.45
MORTALITY RATE
■
Infant
11.2
78.3
81.3
11.6
79.8
i
As per SRS data more than 50% early neonatal deaths and
70% Neonatal deaths are recorded.
For the year 1986, the following
are the P® components:
Bay I to Day 7
57?z’
Day 8 to Day 30
14-5%
Day J1 to D 365
28.5%
: 4
:
The following table gives you Infant Death by age groups
for the years 1981 - 1988.
TABLE
III
INFANT DEATHS BY AGE GROUP 1981-38
AGE GROUP
TAMIL NADU
1985
1984
0/ .
%
/0
1986
a/o
1987
%
. %
40.46
44.62
46.50
45.42
34.62
17.05
15.00
14.79
60.11
61.67 ■ 61.50
60.20
38.33
38.50
39.79
24.66
24.48
23.87
23.70
15.23
13.85
14.63
16.09
1981
1982
1983
%
%
%
40.44
39.57
34.70
Over 1 week
under 1 Mon.
17.11
17.12
20.59
17.85
Neon?, tai
57.55
56.74
55.09
58.31
Post Neonatal
42.45
43.26
44.91
41.69
39.81
over 1 month
upto 6 month
'24.71
28.26
30.30
25.78
Over 6 month
upto 1 year
17.74
15.00
14.60
17.91
Under 1 week
25.49
1980
Lot us now see tha mortality pattern of the Infant Deaths in the
neonatal period.
TABLE
IV
INFANT DEATHS BY CAUSES 1987 & 1988
S.ilo.
CAUSE OF DEATH
Under 1 wk
CRS
TAMIL NADU
Over 1 week
under 1 mon.
TOTAL
%
1988
1988
1987
1988
1987
1929
1988
1720
1987
1. RESP. DIS.
497
454
2426
2174
14-58 14.47
2. OTHER FEVERS
1124
949
768
710
1892
1659
11.57 11.04
5. DIARRHOEA
166
166
161
208
327
374
1.97
4. HEART DISEASES
85
206
33
62
118
268
O.71
1.78
87
68
23
101
91
0.61
0.61
1987
5. TUBERCULOSIS
14
2.49
t 5- s
What is happening to infants, is shown in the next table
TABLE
INFANT DEATHS BY CAUSES
198?
OVER 1 MONTH
UPTO 6 MONTH %
V
- 1988
CRS
' TAMIL NADU
TOTAL %
(of all causes
over 6 months
upto 1 year %
1907
1988
1987
1988
1987
1988
1 . OTHER FEVER
22.46
21.89
21.32
2.’RESP. DIS.
9.82
11.71
18.77
9.04
15.48
13.02
14-85
12."89
11-33
5-11
5.72
2.51
1.02
1.14
2.08
0.54
0.67
5. DIARRHOEA
8.76
11.51
10.11
4. HEART DISEASES
2.24
2.53
12.35
2.80
5. TUBERCULOSIS
0.40
0.59
O.48 '
From the above 5 tables we could, infer
1) On an average 4$“ of infant deaths occur during the early-
neonatal period.
2) 60% deaths are in the neonatal period.
5) As per CHS, respiratory diseases take a major toll in the
early neonatal period.
The second major cause of death is ’fever’
4) Among the late neonates, fever is the predominant cause.
4»i
itf A. fcj by,
5) Respiratory system diseases are the major causes oaths'
v-ojartir tn<> A>Jyr
n
.
early-neonates^ -Jefj^-major cause/ is ’fever’.
mA.
We will now present the
mortality statistics from a
major urban Pediatric Institute viz. Institute of Child Health
and Hospital for Children, Madras.
Table VI shows you the average inpatient percentage
specialitywise
6
TABLE
VI
, PERCENTAGE Oj? INPATIENTS SPECIALITYWISE 1989 .
INSTITUTE OF CHILD HEALTH & HOSPITAL FOR CHILDREN, MADRAS.
8 .No .
SPECIALITY
Admissions
Treated.
Death
%
1.
Medical
18788
17795
1259
7.1
2.
Newborn Medical
2581
2500
587
23.5
3.
SURGICAL
3259
3318
81
2.4
4.
New born surgical
494
583
155
26.6
5.
VACCINE PREVENTABLE DIt>2/kS3S
8J0
888
69
7.8
6.
CARDIOLOGY
91
135
24
17.8
7.
NEUROLOGY
313
357
1
0.3
8.
RESPIRATORY UNIT
105
308
9
2.9
9.
GASTROENTEROLOGY
330
465
27
5.8
396
52
13.1
2144 •
34
1.6
485.!
1
0.2
0.2
.
10.
NEPHROLOGY
218
11.
HEMATOLOGY
2041
12.
E.N.T.
447
13.
ORTHOPAEDICS
483
519
1
14.
CARDIOTHORACIC
111
142
2
1.4
15.
UROLOGY
87
96
1
1.0
30158
30131
2303
f ■' '1
7.6
TOTAL
,
_
!
•
I
<
•«’5'
s 7 :
Table VII shows agewise classification of inpatients.
TABES VII
AGEVIS S C lASSIPIGATIOil OF INPATIEiTTS
& DEATHS IN °/a
1989
AGE GROUP
TREATED
PERCENTAGE
DEATHS
PERCENTAGE
0-6 days
8J5
2.8
416
18.1
7-27 days
1758
5.8
258
11.2
28 days - under’ 1 Yr.
8551
28.5'
777
33.7,
■Infants
(0 - 1 Yr)
11124
56.9
1451
63.0
1 Yr - 3 i’rs.
7575
24.5
406
17.6
7.7
3 Yrs - 5 Yrs
3554
11.7
176
5 Yrs & above
8097
26.9
270
11.7
2503
7.6
TOTAL
50151
Table VIII shows the place of residency of the cases
treated at the Institute of Child Health, Madras.
TABLE
VIII
GEOGRAPHICAL DISTRIBUTION OF CASES TREATED AT INST. OP CHILD HEALTH. 1?89
MADRAS CITY
MADRAS SUBURBAN
OTHER DISTRICTS
15101
8285
5542
1203
50.1%
27.^
18.4’4.
4.0?o
OTIER STATE
5 8 :
Table IX shows mortality % specialitywise
for 'the year 1989
relating to the Institute of Child Health, Madras.
TABUS IX
MORTALITY % SPECIALITY WISE, INST. OF CHILD HEALTH .MADRAS. 1989
1) General Medial
...
7.0%
2) Pediatric Intensive Care Unit
...
81 .5%
5) Vaccine Preventable Diseases Unit
7.8%
4) Newborn - Medical
...
25.^
5) Newborn - Surgical
...
2.0%
6) Pediatric Surgical Intensive Care Unit
50.0%
7) Respiratory Diseases
...
2.9% «•
8) Cardiology
...
17.6$ *
9) Gastroenterology
... .
5.8% *
1O) Haematology
...
1.6% *
11) Nephrology
...
15.0%
12) Neurology
...
i----- ■----- ----- ---- - ---------- -
*
“
0.5% *
----------------------------------------- 1
Chronic cases
Table X shows the major causes of morbidity and mortality for
1989 of all cases treated at the Institute of Child Health and
Hospital for Children, Madras. ’
9
TABLE X
MAJOR CAUSES OF MORBIDITY AND MORTALITY - 1989
S.No.
MAJOR DISEASES “
ALL PATIENTS
HEN BORN PATIENTS
' Total
cases
Deaths
To tel
cases
Deaths
10 Respiratory infections
7882
207
483
55
2. Gastroenteritis
5576
372
357
26
3 = Nutritional deficiencies
5055
67
18
4
4. Conditions originating
in the perinatal period
2J01
385
2049
373
5» Septicaemia
1380
177
635
90
6. Cardiovascular diseases
1043
22
0
0
7• Tuberculosis
1032
50
0
0
80 Anaemias
880
23
0
0
9« Measles
506
42
0
0
455
0
0
0
10. Helminthiasis
■
S)
You could, see from the above table that the _4€F major medical
oases of mortality as seen from a major urban. Pediatric Institute sta
tistics are!
1) Respiratory infections
2) Gastroenteritis
Nutritional deficiencies
4)
Condition originating in the perinatal period
5)
Septicaemia
6)
Cardiovascular diseases
7)
Tuberculosis
0) Anaemias
9) ^easles
. ESSENTIAL
DRUGS
In Tamil Nadu, the following drugs are supplied at the
subcentre levels
l) Tab B Complex
2)’Tab B1B6
j) Tab. Cotrimaxazole (adult) for children above 5 years
4) Tab. Cotrimaxazole (child) for 1 to 5 years
5)
Syp. Paracetmol
6)
Syp. Cotrimaxazole for infants
7)
Syp. Multivit.
8)
syp. Vitamin
9)
ORS packets
■|0) VST tablets
1l) Gentamycin Eye/ear drops
12) Nitrofurdcin oint.
A-fc the primary Health Centre level, the following drugs are
made available.'
Drugs listed at Subcentre level
A)
1.' Penicillin tablets
B)
2.
Chlorophenicol capsules
J. Phetiobarbitone tabs
*
4
Pura2i)lidine tabs
5.
Netranezpil tabs
6.
Diazepam
7.
A T T
8.
Antileprosy drugs (NIEP)
drugs (NTCP)
9.
Tincture Iodine
10.
Inj. Aminophylene
11.
Inj .
12.
*
13
-DaM |>
e
Inj. Dexaraethazone
?V fluids 5>“ dextrose saline
14. IV fluids wf normal saline
15, Inj. Sodium Bicarbonate
16.
All vaccines.
11 :
MORPAUTY STATUS Vs.-ESSENTIAL DRUGS
Let .us now analyse the above mortality figures and the drug
availability
It will not be out of place here if I quote
in Tamil Nadu.
the recent findings
of an International workshop on Rational use of
antibiotics in the community held at Christian Medical College Hospital
Vellore India.
Out of 5, four clinical condition viz. Urinary Tract
infection, Pneumonias, Fevers of short duration and surgical wound
infection are quoted here with relation to their drugs therapy.
It was found that
l) In 71% °f UTI's, one antibiotic was used and in 28.?%
more antibiotics.
Norflaxacin (25.7%), Ampicillin (20.,
Cotrimaxazole (16.?%), Gentamycin (l0.2,'o) and Nalidixic acid (0.5%) were
the drugs used in that order.’
2) In pneumonias 49% of cases received two antibiotics and
JO.&> received single drug.
The freqh- antibiotics used, were Penicillin
or Ampicillin either alone or in combination with Gentamycin.
3? In fevers of short durations 7®° of patients received one
antibiotic and 2zJ% two or more antibiotics.
Ihe commonly used drugs
were Cotrimaxazole, Ampicillin, Chloromphenicol and Erythromycin.
4) In surgical wound infection almost all received one or more
antith tics,$Tombination of 2 or J
antibiotics were common.
Ampicillin,
Gentamycin, (cotrimaxazole either alone or in combination with Hetranidyzole
are the common antibiotics preferred.
This study was conducted in Vellore, North Arcot Ambedhkar and
Thiruvannamalai Sambuvaroyar districts in 1989-90 by questionnaire method.!
• 12 :
It could, be seen from the
above example and. our mortality analysis
in Tamil Nadu that Respiratory infection^are a major problem followed
by Gastroenteritis and fevers of short duration.
FUTURE HEEDS BASED Oil PAST AND PRESENT REALITIES:
l) It is our recommendation that the National ARI control programme is
introduced soon to detect early cases of pneumonia at the subcentre/PHC
level itself so that ARI mortality could be considerably brought down,
the ideally suited primary drug is cotrimaxazole, penicillin, ampicillin,
Amoxylin, gentamycin etc.
are cUuyA ^CliACefor secondary and tertiary
levels care.
2) Liberal distribution and use of OKS packets have
diarrhoeal mortality to a greater extent.
brought down the
Limited drugs like
gentamycin, nalidixic aoid etc. are sufficient oven at MIC lev&l for
complicated cases.,
-
Liberal use of iron folio acid tablets JO - 50 - 40 regimes has
considerably brought down pregnancy associated anaemias.
Same should be
encouraged.
4) Sffective coverage of TT2 of eligible pregnant women lias brought down
the incidence of Neonatal Tetanus to I.4/1OOO LB in Tamil Nadu.
Deaths are rather unheard of.
Maternal
•
5)Remarkable decline in Vaccine preventable diseases
(Diphtheria 98%)
Rertussis (60%), Tetanus older children (50%), Tetanus new born (97j)
Poliomyelitis (60%) are attributable to over 80% immunization coverage with
DPT 3 and OPV 5.
Measles remains to be combated yet with only 50%
Measles vaccine coverage.'
: 13 :
6)
In ICDS project areas of Tamil Nadu 57 projects are mostly in rural
sectors, the H'lH has come down and. VPD’s have declined,.
Acute respiratory
infections including measles related pneumona need to be cotabated.
?)
Perinatal and Neonatal care has to be intensified as still 60%
_f IMR are attributable to this vital period of the infant's life.
It may therefore be concluded that the rational approach to
Essential drug therapy in primary health care should be based on
prioritization of the causes of morbidity and mortality, taking into
consideration the MCH care intervention and non intervention areas.
A
close coordination between the planners and the health personnel involved
in primary health care is the need of the hour.'
ACKNOv/LEDCTIEHT
We are grateful to the following officers for their guidance and
help in providing tine statistical data.
l) Dr. M.G. Muthukumaraswamy, Director of Primary Health Csntres, Madras
2) Dr. A. Ramalingeswara Rao, Director of Public Health & Preventive
Medicine, Madras
3)
Dr. E.S. Rahavendra, Director of Public Health & Preventive Medicine
(Training and Continuing Medical Education)
4)
Hr. A. Kuppuswamy, Additional Director of Public Health and
5)
Mrs. Mercy Ebehezer,- Statistical Officer, Directorate of PH <x PM, Nadrai
Preventive Medicine & State Immunization Coordinator.
o) Thiru S. Sivaretnam, Sr. medical Reco.rd Officer, Institute of
Child'Health, Madras.
7)
Thiru D. Natarajan, PC to the Director, Institute, of Child Health
Hospital for Children, Madras for secretarial Assistance.
: 14 ’•
REFEREtICSS:’
l) Profile of Infant Mortality in Tamilnadu. Mrs. Mercy Ebenaser -
Personal Communication
2) Year Book 1339, Medical Records Department, Institute of Child Health &
Hospital for Children, Madras. Ed. S. Sivaretnam
j) North Ajcot Hiiruvannamalai Districts Health Information Bulletin -
Nathi - Vol. 7 No. 4 - April 90
4) Essential drugs in Primary Health care - Workshop proceedings.’ Indian
■ Journal of Pediatrics. Vol. 56 No.1 Dinesh Paul.
'M:/-
.
HEALTH FOR ALL -
w)
ALL FOR HEALTH
W
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
MESSAGE FROM
DR U KO KO
Regional Director
World Health Organization
Regional Office for South-East Asia
New Delhi
When disease strikes, as it so often does, it has to be fought with potent weapons
and overcome. And an indispensable part of the armamentarium are drugs.
It is, however, not a simple matter. In fact, it is very complex considering
that at any given time, there may be as many as 25,000 drug preparations available
in some countries. To add to the problem, many are not easily available. Those that
are, are usually beyond the means of most.
Keeping all these issues in mind, the World Health Organization convened a
meeting of experts in 1977 which, after considered deliberations, concluded that
about 200 drugs and vaccines could be considered essential to satisfy the health
care needs of the majority of the population. Since then, a remarkable revolution
khas taken place in the area of drugs and pharmaceuticals, with different countries
"further reviewing the list of 200 essential drugs and developing lists more suited
to their specific situation.
WHO's Action Programme on Essential Drugs is aimed primarily to ensure the
regular supply to all people of safe and effective drugs of acceptable quality at
the lowest possible cost. This is very much in keeping with the Declaration of
Alma-Ata, which, while identifying the eight essential elements of primary health
care as the keys to achieve the goal of health for all by the year 2000, listed
essential drugs as a major element. For it is only when such drugs are easily
available and rationally used that the war against disease will eventually be won.
It is hoped that "an informed public" will find the contents of these papers
informative and useful and thus be better equipped for this war.
WH040/1988/0ctober/l
The material in this Information Kit is intended for media/public use and does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization, Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
HEALTH FOR ALL ALL FOR HEALTH
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
In this world, there is, on the one hand, an over-consumption oi drugs
and on the other an appalling dearth. Millions of people are compelled to
go without medicines that could save their lives, prevent them from
having to endure an existence of physical handicap, or relieve them of
intolerable suffering.
The WHO Action Programme on Essential Drugs and Vaccines seeks to ensure that
all people, wherever they may be, are able to procure the drugs they need at a
price they can afford.
WH040/1988/0ctober/2
The material in this Information Kit is intended for media/public use and does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization,
Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
HEALTH FOR ALL ALL FOR HEALTH
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
FACTS
If prophylaxis is one side of the coin, therapy with essential
drugs is the other in health care. It plays an important
role in protecting, maintaining and restoring health
of the people - and at a cost most can afford.
THE PROBLEM
- There is a high level of morbidity, particularly in the developing countries.
- People want their illness to be relieved or cured expeditiously without being
subjected to the ill-effects of therapy. They also want it at a price they can
afford.
- There is a plethora of drugs available in all countries marketed by the
pharmaceutical industry not necessarily to fulfil the needs of any particular
country or people.
- To meet the needs of the sick, there
resources, both manpower and financial.
is
a great
strain on
the
country's
- Several countries are spending almost upto 40 per cent of their total health
budget on drugs.
- Large resources are spent on "fire fighting" illnesses with the result that for
the more important promotive, preventive and rehabilitative health activities
resources become scarce.
ESSENTIAL DRUGS
Essential drugs form an important element of primary health care. While drugs do not
buy health, they certainly save lives and money when used discriminatingly. The
indiscriminate use of drugs does not merely lead to expending of scarce resources
which could otherwise have been spent for buying nutritious food which is so
WH040/1988/0ctober/ 3
The material in this Information Kit is intended for media/public use and does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization, Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
essential drugs save lives and money
important to health, but the injudicious use of drugs could also cause what are
called "drug-induced diseases", for example, blood disturbances caused by analgin.
Most countries in the world spend large sums of money on drugs. It is reported
that the world market of pharmaceuticals at the retail prices has almost reached
US$100 billion. Several developing countries are spending as much as 40% of their
health budget on purchasing drugs. Since a substantial portion of the total health
care budget is thus spent on drugs, the cost of health care has risen and funds
available for the more important promotive and preventive activities have become
scarce. Although this is indeed a global problem, it has affected developing
countries more acutely due to the very limited financial resources available in such
countries.
Concept of Essential Drugs
It is now recognized that it is possible to treat most patients using only a few Ay,
drugs which have proven therapeutic value, assured quality, and are economically
priced. Such drugs are to be considered as "essential drugs", indicating thereby
that they are necessary for the health needs of the population of a country.
Essential drug care is thus a public health approach in drug selection.
Unfortunately, most countries have not accepted this concept, despite the fact
that the indiscriminate use of drugs may lead to "drug-induced distress" and to the
expenditure of valuable and scarce resources. It is now known that the excessive use
of antibiotics and other inappropriate drugs to treat infections has given rise to a
predominance of micro-organism resistance to several commonly used antibiotics. This
has illustrated how important it is to use appropriate drugs depending upon the type
of disease, the environmental situation, the competence of health personnel, other
characteristics and dietetic habits, bringing benefits both to the patient and to
the community.
Advantages of Essential Drugs
1.
Fewer drugs would mean less storage space, money, infrastructure for purchases,
efforts for distribution and quality assurance.
2.
There would be improvement in drug management, dissemination of information to
health personnel and the community, improved patient compliance, better
monitoring of drug adverse reactions, if any, and their prompt treatment.
3.
Fewer drugs would tend to stimulate local production of pharmaceuti- cals,
wherever feasible, sparing valuable foreign exchange for more important
community needs.
H
HEALTH FOR ALL ALL FOR HEALTH
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
RATIONAL USE OF DRUGS
"A desire to take medicine is, perhaps, the great feature
which distinguishes man from other animals".
- Sir William Osler, 1891.
Human beings have for centuries employed simple, low-cost traditional remedies for
centuries to relieve their ailments and diseases. Some of these remedies did cure or
at least provide symptomatic relief. Most produced some mild reactions but rarely
any ill-effects in a patient. The last four decades have, however, seen a large
number of potent drugs being added to the therapeutic armamentarium of the
physician. The value of world consumption of drugs has increased dramatically to
over 100 billion US dollars.
In the developing countries this is indeed a problem. To begin with, very
scarce resources are provided for health development, with not more than 3-4% of the
total public sector budget outlay spent on health. Yet, many of the countries con
tinue to expend 30-40% of their valuable resources on buying drugs. In the markets
of the developing countries are seen a large number of drugs and their combinations.
Patients, with fevers which are usually self-limiting, are treated with, and even
rdemand, potent medicines like antibiotics. Sometimes as high as 70% of drug prescrip
tions are for combination products. Doctors use one or sometimes a combination of
antibiotics to bring about a "quick cure", not realising how dangerous it is to
expose human systems to very potent chemicals which are alien to the human body.
In one country in the South-East Asia Region of WHO, there are some 20
different drugs to treat pain and some 15 different drug combinations to treat
allergy. Doctors, . flooded with literature on different drugs manufactured by
pharmaceutical companies, are often bewildered and even unable to remember the
ingredients of a drug combination which they prescribe for their patients. Since
most drug products are marketed under a brand name, prescribing physicians are
unable to recall what active substances a brand product contains. These are likely
to lead to errors; prescribing an over-dose or under-dose of a drug results in
serious and harmful consequences.
A new culture has developed. Patients have come to believe too much in the power
of a drug and, with a doctor ready to satisfy the patient's expectations, it is not
uncommon to find that antibiotics are prescribed for a cold, sedatives for a mild
agitation and tonics given to almost every patient for 'building their strength'.
WH040/1988/0ctober/4
The material in this Information Kit is intended for media/public use and does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization,
Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
2
ESSENTIAL DRUGS SAVE LIVES AND MONEY
There is also the 'injection mania': the patient expects or even demands an
injection, believing in its magic curative properties.
Rational use of drugs implies that doctors and health workers must choose appro
priate drugs for their patients in adequate dosage and, as far as possible, prescribe
a single drug. Two or more drugs administered together may produce interactions which
could be dangerous or even fatal. Some drugs are known to produce fatal effects when
taken after eating certain types of food. It is, therefore, dangerous to resort to
polypharmacy. Fixed ratio combinations are only justified if they are proven to
improve patient compliance, to assure safety, enhanced effect or to reduce cost of
treatment. The cost of drug treatment must also be taken into account so that
patients are put to minimum financial strain. It must be remembered that a patient
does not choose a drug for himself or herself. It is the prescriber who makes that
choice and thus on the prescriber devolves a great moral responsibility to make an
appropriate choice.
Today's drugs are, indeed, like "specific bullets" aimed against disease. But
they have to be used in appropriate doses and individualized for a patient. There
are many factors which govern drug response: drug absorption, its fate in the body,
its rate of disposal, the nutritional status of a patient, the presence of liver or
kidney disease, the habits of the patient and the patient's environment. It is
indeed a very complex situation. Prescribing drugs is a serious measure, it should
not be taken lightly by a physician.
All drugs produce some degree of ill-effects; some of these are moderate and may
be self limiting. Others may produce fatal reactions. Such disastrous effects may be
seen soon after taking the drug or sometimes may not manifest for days or even years.
In known cases they are seen, in fact, only in the next generation as genetic ab
normalities or cancer promoting effects., e.g. the drug thalidomide used during preg
nancy which produced malformed babies having congenital absence of all four limbs.
Irrational use of drugs is harmful not only to the individual patient but also
to the community. Extensive and irrational use of antibiotics has resulted in the
emergence of resistant bacteria which are a source of dangerous and fatal infections
in hospitals (Nosocomial). In a recent outbreak of dysentery in some of the
developing countries patients could not be cured by the available antibiotics,
because the germs had become resistant to the commonly used therapeutic agents.
ROLE OF WHO
WHO has been actively promoting the rational use of drugs. Since physicians,
pharmacists and health workers are all involved in providing primary health care,
WHO is providing appropriate information on drugs to all such groups. WHO has
produced drug information bulletins, a primary health worker manual on essential
drugs, in-service training programmes for rational drug use and drug formularies.
Besides, WHO has emphasized a need to examine and review undergraduate curricula for
medical, nursing and pharmacy students in order to train them in the concept of
essential drugs, and rational prescribing.
One aspect which has often been neglected in the past is information that is
needed to be given to a patient. Ignorance on the part of a patient can be a major
obstacle to the rational use of drugs. The use of mass media to advise the patient
and the community to improve drug compliance must be explored. Educational
materials, posters and handouts have been produced by WHO.
WHO has also promoted research on the socio-economic and behavioural patterns
of communities and on drug utilization studies in developing countries. Such studies
would provide the health planner useful information for evolving appropriate
interventions to encourage rational use of drugs.
The active promotion of essential drug concepts by WHO has also resulted in
restructuring of resource allocations and in the optimal utilization of the
available scarce resources.
HEALTH FOR ALL -
ALL FOR HEALTH
(I®
w
ESSENTIAL DRUGS SA VE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
ESSENTIAL DRUGS SAVE MONEY
Most developing countries today face a serious financial crisis as a consequence of
global recession. There is great concern at the increasing health costs. Faced with
" little prospects of increased budget allocations and the rising inflationary trends,
health ministries of developing countries have to evolve appropriate strategies to
provide optimum health care within the allocated financial resources.
a
Since there is a high morbidity rate in most developing countries, it is quite
understandable that drugs have to play an important and vital role in health care.
A substantial portion of the health budget is expended on purchase of drugs. In
some countries, the cost being as high as 30% of the health budget outlay, little
funds are spared for the more important preventive and promotive activities.
Economic considerations, therefore, influence health care decision-makers and this
has often resulted in searching for 'short-cuts' in health development rather than
the more important plans for long-term investments which alone can ensure positive
health. Several drugs marketed both in developed and developing countries are priced
high, especially under brand names. Since consumers, namely, the patients, get their
drugs only through the Intermediary of a health personnel, they have hardly any
choice to pick and choose what is most economical to their pockets. This tends to
increase the expenditure of individuals and families, leaving little for other
necessities of life. Besides, the public sector health institutions which cater to
the health needs of the majority in developing countries have to provide greater
outlays on drugs than on immunization, prevention and control of infectious diseases
and promotive activities.
Drug prices have become a nightmare for the common man. Irrespective
of the political or economic value system, it is inevitable that
some patients will not receive the medicines appropriate for
their illness. This is inequitous and it becomes necessary
to ensure that the good of the majority reigns over the
privileges of the few.
WH040/1988/0ctober/5
The material in this Information Kit is intended for media/public use and does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization,
Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
2
ESSENTIAL DRUGS SAVE LIVES AND MONEY
"Essential drugs", on the other hand, are priced economically and, therefore,
individuals and institutions using only essential drugs spend less on drug bills.
There is, thus, substantial saving for other relevant health development activities.
After all, the per capita health expenditure in several developing countries is only
about USj>3, and even lower in the least developed countries. How important it is,
then, to save every cent for preventing diseases.
On an average, it is reported that there are three episodes of illness per year
per person. A middle- or low-income group family of five members has, therefore, to
spend approximately more than 5% of its meagre budget on drugs. Since almost 70% of
the population in a developing country has to depend upon public sector institutions
for health care, there is also a strain on resources allocated to health,
necessitating their optimal utilization. Excessive prescribing, irrational use of
drugs, wasteful expenditure on drugs of doubtful value, wastage due to improper
storage, poor quality of medical care, vagaries of procurement and distribution
systems, are some of the serious problems faced by most developing countries. If
there are too many drugs made available in a country, the drug management system
suffers; besides, the country has also to pay a substantial price for these,
regardless of whether they are obtained through the public or private sectors.
Many countries are still dependent upon international procurement to meet their
drug needs. There is consequently a wasteful expending of foreign exchange which is
so valuable for buying food and other items for socio-economic development. Thus, by
pruning down drug imports and procuring only those drugs which are most essential to
meet health needs of a community, foreign exchange can be saved. The essential drug
concept is, therefore, of significant economic importance to the developing world.
Essential drugs are not patented. These are available under generic names at
economic prices. A regulatory control on quality has, of necessity, to be assured.
These drugs are most cost-effective. They are safe and efficatious. Thus, they not
only save lives but also money, for the individual, the community and the nation.
HEALTH FOR ALL -
ALL F0R HEALTH
wB
W
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
ESSENTIAL DRUGS : A KEY ELEMENT IN PRIMARY HEALTH CARE
4 The International Conference on Primary Health Care
(PHC) held in Alma Ata in
September 19 78 declared, inter alia, that primary health care was the key to
attaining the goal of Health for All by the Year 2000. It stressed that primary
health care should focus on the main health problems in the community and
recommended that primary health should include, at least, the following elements:
1.
Education concerning prevailing health problems and the methods of identifying,
preventing and controlling them;
2.
Promotion of food supply and proper nutrition;
3.
An adequate supply of safe water and basic sanitation;
4.
Maternal and child health care, including family planning;
5.
Immunization against major infectious diseases;
6.
Prevention and control of locally endemic diseases;
7.
Appropriate treatment of common diseases and injuries;
8.
Provision of essential drugs.
WH040/1988/0ctober/b
ESSENTIAL DRUGS SAVE LIVES AND MONEY
2
From the point of view of implementing a good primary health care system
encompassing the whole country it is vital to have a list of drugs which are not
only comprehensive but are chosen as essential on the basis of specific criteria.
These criteria could include disease morbidity patterns, diseases of public health
significance, drugs with high benefit/risk ratio, drugs that are economical and easy
to manufacture, drugs containing a single ingredient, etc. It is equally important
to recognize the value of traditional systems in providing succour and thus include
traditional medicines suitably in the overall lists of drugs for primary health
care. The drugs included in such a list (which can then be termed "essential drugs")
must not only be commensurate with the existing spectrum of disease in the
community/country, but must also be of adequate quality and be available in
abundance at the primary health care level to meet the health needs of the people.
Factors affecting the selection of
drugs for primary health care
A WHO Expert Committee on the Selection of Essential Drugs recommended some time ago^
the compilation of a separate list of drugs appropriate for use in primary health
care. Having regard to situations in which a traditional healer or community health
worker rather than a qualified doctor is the patient's first point of reference,
they selected 22 substances or types of substance .
A model list of drugs for primary health care
acetylsalicylic acid
activated charcoal
an antacid
an antihaemorrhoidal drug
atropina (antispasmodic)
benzoic acid + salicylic acid
benzyl benzoate
calamine lotion
chlorhexidine solution
chloroquine
chlorphenamine
ephedrine (asthma)
ergometrine (postpartum haemorrhage)
iodine
ipecacuanha
iron/folic acid (nutritional supplement during pregnancy)
lindane
mebendazole
oral rehydration salts
paracetamol
piperazine
tetracycline eye ointment
It cannot be emphasized too strongly that, in practice, the selection must be
determined nationally since the training and responsibilities of these workers vary
within wide limits. The following considerations, however, will inevitably influence
the content of the list:
(1) Existing systems of medicine. The establishment of primary health care
services should not result in abrupt disruption of prevailing cultural patterns in
rural communities, but the work of traditional healers should be adapted and
supplemented in such a way as to ensure that innovation is successfully integrated
into existing systems of care.
ESSENTIAL DRUGS SAVE LIVES AND MONEY
3
(2) The national health infrastructure. The type of primary health care
service that a country requires is dependent upon the proximity and nature of the
first referral facilities. It is still not unusual in some countries for the nearest
permanently manned health post to be one or more days' travelling time from isolated
villages in its catchment area.
(3) Training and supplies. The numbers of trained personnel, the facilities
placed at their disposal, and the supplies entrusted to them determine both the
scope and the limitations of the primary health care system. Workers with one or
more years' vocational training can obviously accomplish more than personnel who
rely upon an intensive course of practical instruction lasting only a few weeks.
But, whatever the circumstances, little can be accomplished unless continuity of
essential supplies and information is assured.
(4) The pattern of endemic disease.
The
prevalence of major endemic
infections and parasitic diseases may vary from region to region, and within a
country in conformity with climatic, geographical, topographical, social, economic,
\and occupational factors. Careful planning and, in some cases, epidemiological
’surveys are required to ensure that the most effective drugs are provided, and to
obtain full benefit from limited resources.
MANAGEMENT OF ESSENTIAL DRUGS
-
a
committee
consisting
of
representatives
pharmacology and pharmacy, and peripheral health workers.
Appoint
from
medicine,
Select and list the essential drugs.
-
Identify drugs and pharmaceuticals under generic names.
-
Provide a cross index of non-proprietary and proprietary names.
-
Prepare concise, accurate and comprehensive drug information.
-
Assure quality, stability and bio-availability of drugs.
-
Organize
efficient
administration
of
drug
supply,
storage
distribution (with a special facility for short-life products).
and
Manage efficiently the drug stock.
-
Plan stock inventory.
-
Control the production and sale of drugs.
-
Conduct
research -
chemical
and pharmaceutical,
to
help
evaluate which
product is best.
The selected drugs can be used effectively and safely by responsible
individuals with little formal medical knowledge. The list is adapted to the needs
of a malarious area (free from chloroquine resistance) where helminthic infestations
are also endemic; the instructions for using the drugs can be based upon the
recognition of a few basic clinical signs and symptoms.
The World
Health
Organization's action
programme
has
resulted
in
a
comprehensive list of 200-250 'essential drugs', including vaccines,
salts,
nutrients and vitamins. It has had a favourable impact on many developing countries
and has helped them in developing their own list of essential drugs for primary
health care. At intervals, a constant evaluation and ranking of products with regard
to their therapeutic value for each indication and the prevailing economic condition
must be undertaken.
HEALTH FOR ALL ALL FOR HEALTH
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
ACTION PROGRAMME ON ESSENTIAL DRUGS
Countries in the South-East Asia Region have made determined and concerted efforts
^towards the goal of health for all by the year 2000. Health for All has now become a
* movement for health development,
sharply focusing on improved management,
strengthening of infrastructure and absorbing and applying appropriate health
technology through the primary health care approach.
The last few decades have seen considerable progress in the pharmaceutical
field. While most Governments prior to 1950 were trying to focus their attention
mainly on quality, the thalidomide tragedy brought into sharp focus the problems of
safety of drugs. The growing attention on drug policies has sharpened. Since a
substantial portion of the health budget is being siphoned for drug purchase, the
socio-economic aspects of drugs have attracted a great deal of attention of health
planners and managers in the developing countries. Drug policies have gained added
relevance because of health policies which are aimed at restructuring health
development so as to provide maximum benefit to the under-served and unserved for
achieving health for all by the year 2000.
International actions have, therefore, been centered around ensuring the
accessibility of drugs to the population of developing countries based on their
needs. Pharmaceuticals have thus crossed over from mere technical considerations to
more relevant social and economic considerations.
Realizing that the developing countries are handicapped by meagre financial
resources and that the expenditure of drugs may constitute as much as 40% of their
total health budget, the Twenty-eighth World Health Assembly in 1975 drew attention
to the necessity of "developing drug policies linking drug research, production and
distribution to the health needs of different countries".
The pharmaceutical supply system is one of the most crucial issues in
developing countries. This is reflected in Resolution No. 25 adopted by the Fifth
Conference of Heads of States of Government of Non-aligned Countries held in Colombo
in 1976 which also emphasized the need for cooperation among developing countries in
the pharmaceutical sector.
Drug Policies
While drugs alone are not sufficient to provide adequate health care, they no doubt
play an important role in protecting, maintaining and restoring the health of the
WH040/1988/0ctober/7
The material in this Information Kit is intended for media/public use a.nd does
not constitute an official document. Additional copies may be obtained from:
Public Information Unit, World Health Organization, Regional Office for
South-East Asia, Indraprastha Estate, New Delhi-110 002, India.
ESSENTIAL DRUGS SAVE LIVES AND MONEY
2
people. This is particularly so in the developing countries where
still continues to be at a high level.
the morbidity
In recent times, there have been unprecedented advances in the field of drug
research. Several transnationals have marketed drugs with not much concern for the
health needs and priorities of developing countries. Thus there are several drugs
for relieving pain and joint swellings, myriads of drugs for blood pressure or
coronary heart disease and many antibiotics for treating infections.
One of the major constraints identified by WHO is the lack of a well-defined
drug policy as a part of a country health policy to ensure supply of essential drugs
for the health systems based on the primary health care approach. Since the aim of
developing a national drug policy is to improve the efficiency of the pharmaceutical
supply system through definite objectives and through cooperation and coordination
between the different sectors involved, WHO, in the South-East Asia Region, has
emphasized a need at the national level to develop a country specific drug policy.
The implementation of the drug policy is through a legal instrument, namely,
legislation, giving both the responsibility and authority to the government to
regulate the pharmaceutical supply system to achieve the objectives of the drug
policy.
Essential Drugs Concept
It is recalled that it is possible to treat most patients with only a few drugs
which have proven therapeutic value, assured safety, and are economically priced.
Such drugs are to be considered as "Essential Drugs" indicating thereby that they
are necessary for the health needs of the population of a country. The Essential
Drugs concept is thus a public health approach in drug selection.
Production Facilities
Several countries in this region have established facilities for production of
drugs. India and Indonesia are self-sufficient in the formulation and also produce
some basic pharmaceuticals or bulk drugs. WHO has collaborated with countries in the!
training of personnel for production, establishment of production technology,
introduction of Good Manufacturing Practices (GMP) and generally strengthening of
infrastructure.
Procurement
Several countries are procuring their drug requirements through import. The
procurement system has to be rationalized through training in managerial processes
and market intelligence which is the pre-requisite for obtaining quality products
from economic sources. The WHO certification scheme is one mechanism utilized by
several countries to assure quality of drugs imported from countries participating
in the scheme.
Quality assurance
The cain thrust of the WHO programme on pharmaceuticals is to develop the
capabilities of the countries of the South-East Asia Region in all aspects of
quality assurance. WHO collaboration is in the field of training manpower, both
technical and managerial; strengthening the infrastructure of the drug testing
laboratories through supply of equipment; introducing methodology for drug analysis,
training of nationals in GMP; developing adverse drug reaction monitoring centres;
establishing a network of collaborating centres, and participating in the WHO
certification schemes.
ESSENTIAL DRUGS SAVE LIVES AND MONEY
3
SEVEN STEPS TO SUCCESS IN ESSENTIAL DRUGS *
SUPPLY
1. National Drug Policy: Every country's
comprehensive health policy should include
a National Policy on Essential Drugs. WHO's
role is to inform governments about the
basic concept and the benefits. A national
essential drugs policy can provide more
drugs to more people at the same cost or
even less.
2. Selection
of
Essential
Drugs:
Essential
drugs are those that satisfy the health care
needs of the majority of the population. More
than 80 countries have now adopted lists of
essential drugs based on WHO's Model List of
Essential Drugs, as have various nongovern
mental organizations and UN agencies.
3. Drug Procurement: Often, countries pay more than
they need to for their drugs. UNICEF and WHO help
countries to strengthen their procurement systems and
to
secure,
if necessary and possible,
reliable
financing - internal or external - for their purchases.
of Supply: WHO's goal is to make sure that
people can get the 20 most needed essential drugs whenever
they require them, within an hour's travel.
4. Logistics
5. Proper Use of Drugs: Both health professionals and the general
public are in need of better information and education about when
and how to use drugs. Drug information sheets are being considered
by WHO that would give the indications, contra-indications and
side-effects of essential drugs.
6.
Quality Control: Essential drugs must be of reliable quality as well
as efficacious and safe. Quality has to be assured up to the time that
the drugs are administered, by good manufacturing practices and by
monitoring of products at all stages in the supply line. Any country
lacking quality control laboratories can obtain an assurance of the
the WHO
quality of imported products at the time of export through
Certification Scheme on the Quality of Pharmaceutical Products Moving in
International Commerce.
7.
Training:
Many countries
lack
staff
trained
in
policy
formulation,
selection, procurement, management and use of drugs; in drug legislation and
regulatory control; and in production and quality control. WHO is approaching
universities,
training
schools,
nongovernmental
organizations,
and
the
pharmaceutical industry for help with training materials and courses.
*From World Health, July 1984
4
ESSENTIAL DRUGS SAVE LIVES AND MONEY
Drug Ethics and Marketing Code
These are issues agitating developing countries for several years.
Some countries
have taken steps for an appropriate drug information system and also for incorporat
ing in their legislation or regulation such problems as human experimentation, etc.
There is need for a code of ethics for manufacturers, importers, distributors,
prescribers and consumers. WHO has now provided guidelines for Drug Ethics.
Drug Information
Different types of information on drugs are required depending upon the groups to
which they are directed. Clinicians and other health professionals would need to
know more about the mode of action, indications, contra-indications, adverse drug
reactions, drug interactions, dosage required, pharmaceutical preparation, shelf
life, stability at ambient temperatures etc. Drug information is provided through
several mechanisms such as medical literature, information bulletins, university
courses, product write up, package insert, advertising and through national
formularies, seminars and conferences. In most developing countries information to
consumers is negligible and information to medical and other health personnel is
mostly through manufacturers directly or through their medical representatives.
WHO has supported countries in establishing mechanisms for drug information
such as publication of national formularies and preparation of drug information
sheets.
Community participation
Several countries in the Region have initiated programmes in support of primary
health care through innovative approaches. One such innovation in regard to
availability of essential drugs is through village cooperatives in Thailand and a
similar pilot-scale project in Nepal.
Three thousand villages in Thailand have already successfully started their own
village cooperative medical stores. At the outset, the villages contributed seed
money approximately US$1 each, to start the cooperative store for the purchase o&
* ,
essential drugs. As the amount collected would not allow purchase of a reasonabl^'
stock, the government helped by providing to each cooperative three months supply of
drugs. The village worker responsible for the store, also trained to diagnose simple
problems, sells the drugs at a fixed price (which is at least 20% cheaper than that
available in the market) to the villager. From the money received he is permitted a
deduction of 5% for his personal effort. The remainder is utilized to purchase a
fresh stock hence the imprest stock is replenished. The activity is closely
supervised by the district health authorities. The success of the project can be
evaluated from the fact that it is spreading rapidly to other villages.
Drug Prices
Accessibility of essential drugs to the population in need has to be improved.
Affordability is directly linked with the purchasing power of the population and the
drug prices. Although some countries have controlled drug prices, some people still
cannot afford to buy essential drugs. Several countries have taken initiatives for
appropriate pricing policies.
CONCLUSION
Essential Drugs form an important element of primary health care. When used
appropriately and rationally, they save lives and money. Their indiscriminate use,
however, could expend scarce resources which could be very critical in a developing
country for buying food to improve nutrition and prevent disease.
HEALTH FOR ALL ALL FOR HEALTH
ESSENTIAL DRUGS SAVE LIVES AND MONEY
INFORMATION KIT
OCTOBER 1988
WHO ACTION PROGRAMME ON ESSENTIAL DRUGS
The goal
is to ensure that by 1990, almost all peoples in
developing countries are assured of the supply of essential drugs
when they need these.
The programme is assisting countries
policies and management and improve
pharmaceutical supply system.
to develop rational drug
the efficiency of their
WHO activity is focussed on enabling countries to select a list
of essential drugs and establish mechanisms at country level for
reviewing and updating the list.
In South-East Asia, WHO's major thrust is also to improve the
country capabilities to establish quality assurance programmes at
the national level so as to ensure safety, efficacy and quality
of drugs.
ACHIEVEMENTS IN THE SOUTH-EAST ASIA REGION OF WHO
The WHO Action Programme on Drugs has assisted several countries in South-East Asia
to develop drug policies and management and promote the concept of essential drugs.
The total WHO budget for 1988-1989
South-East Asia Region is US$2.04 million.
for
the
Essential
Drugs
Programme
in
In Bhutan US$1.2 million have been mobilized for developing a drug programme
to ensure support to primary health care.
Ten million dollars have been mobilized through S1DA, DANIDA and WHO to assist
Bangladesh to develop a programme on essential drugs.
2.5 million dollars are being mobilized for the essential drugs programme in
Burma.
Nepal has been assisted through extra-budgetary
different facets of the essential drugs programme.
resources
to
strengthen
Sri Lanka has received substantial extra-budgetary resources for developing
drug
policies,
management,
establishment of
an essential
drugs
list
and
qualification of drug requirements based on the morbidity pattern.
WH040/1988/0ctober/8
2
ESSENTIAL DRUGS SAVE LIVES AND MONEY
Photo WHO/C. Stauffer
Towards Implementing the Teaching of Essential Drugs and Rational
Therapeutics in Undergraduate Medical Education
A note for the Rajiv Gandhi University of Health Sciences (RGUHS)
By
Drug Action Forum - Karnataka (DAF-K) and Community Health Cell (CHC)
1.
Introduction
1.1
As the RGUHS is in the process of reviewing the II MBBS curriculum it was
considered appropriate to support, the process by putting together current thought
and practice about the teaching of rational therapeutics and essential drugs.
The progressive manner in which the I MBBS curriculum was recently revised
suggests that a similar approach will be adopted for the II MBBS.
1.2
The RGUHS has already stated in its ‘Objectives of Medical Graduate Training’
the need for students to “be familiar with the administration of essential drugs
and their common side effects” (RGUHS, 1997, p4). In this it reinforced the
recommendations of the Medical Council of India (MCI, 1997, p6).
1.3
Concerning Pharmacology, the recent subject-wise curriculum of the MCI,
Regulations states that “the broad goal
is to inculcate the rational and
scientific basis of therapeutics” (ibid p27). Under Objectives it has recognised
the need to “integrate the concept of rational drug therapy in clinical
pharmacology” and “state the principles underlying the concept of Essential
Drugs (ibid, p28). Integration of pharmacology with clinical disciplines and
reinforcement during internship has been highlighted eg., under Community
Medicine to “gain information on Essential Drugs and their usage (ibid, p70).
1.4 These statements are in keeping with recommendations of global bodies such as
the World Health Organization since the mid 1980s (IOCU, 1988). This has
resulted in global awareness and action and in the development of the Educators
for Rational Drug Use (ERDU) which is a “global network of teachers and
administrators of schools of medicine and pharmacy as well as consumer and
public interest groups working to introduce changes in undergraduate medical
and pharmacy curricula by incorporating the concept of essential drugs and
rational drug use (IOCU, 1988, back cover).
Thus the need for teaching regarding Rational Drug Use and Essential Drugs
has received recognition by bodies at different levels. Introducing this teaching in
the affiliated colleges of the RGUHS and influencing knowledge and therapeutic
practice among staff, student and young graduates offers many possibilities and
challenges.
1
2.
3.
The Current Scenario
2.1
Despite recommendations and drug action efforts the current Indian
pharmaceutical scene is flooded with essential, non-essential, bannable and
hazardous drugs prescribed by qualified allopathic doctors and others. There is
evidence of irrational use of drugs. Studies also indicate the strong and
dominant role played by pharmaceutical companies in the education of doctors
and the relatively weaker role played by Universities and medical colleges
particularly in continuing education. The ICSSR-ICMR Health for All report, >381
noted that “eternal vigilance is required to ensure that the health care system does
not get medicalized, that the doctor-drug producer axis does not exploit the
people, and that the abundance of drugs does not become a vested interest in illhealth”
2.2
The growing commercialization of medical practice has aggravated irrational
therapeutic practices. This is occuring alongside an increase in drug prices and in
a situation in which a substantial proportion of the population live in conditions
of poverty. The economic costs to patients, their families and the country
resulting from irrational drug use is difficult to bear and also unnecessary.
2.3
Feedback concerning pharmacology teaching from medical graduates with work
experience in rural and primary health care situations found that coverage was
too theoretical and exhaustive with time spent on drugs not currently in use
(Narayan T & Narayan R, 1993). The making of mixtures and experimental
pharmacology was considered not very useful. Time spent on this could be
diverted to “rational therapeutics focussing also on cost effective management”
and “the use of essential drugs as given by WHO” {ibid, p 34-35).
Suggestions for introducing the
undergraduate medical teaching.
Essential
Drug
Concept
(EDC)
into
3.1 Staff need to be sensitized to the concept through workshops and seminars. The
curriculum needs to be modified and changes defined (IOCU, 1988).
3.2
Specific recommendations include (ibid)'.
A) Student sensitization could begin in the I MBBS through general lectures on
health, sociology and behavioural sciences.
B) The Essential Drug List may be introduced in the first few lectures in
Clinical Pharmacology, including the criteria of need, efficacy, safety and
cost that underline their choice. A few lectures about risk-benefit ratio, cost
benefit ratio and Iatrogenesis could be included. Different lists for primary,
secondary and tertiary health care need explaining.
2
C)
In paraclinical and clinical departments, problem solving, active learning
methods are encouraged - eg., studying prescriptions, organising integrated
teaching including seminars with general practitioners, and undertaking
small studies based in the teaching hospital, in pharmacies and with general
practitioners. Relating knowledge to practice is important.
D)
The use of case studies giving symptoms and signs of a patient along with a
prescription generate a lot of discussion and learning (NTTC, 1989).
E)
Weekly bedside clinical pharmacology teaching and studying drug dosages,
selection of therapy, antibiotic sensitivity patterns, cost effectiveness, drug
interactions and side-effect are very helpful. Studies of drug utilization
patterns in the community and exposure to traditional medicine / Indian
Systems of Medicine is also suggested. (Thomas M, 1986).
F)
If each medical college could offer CME programmes including contact
programmes on Clinical Pharmacology and Rational Use of Drugs to its
alumni, it would improve the quality of therapeutics (ibid). This will also
counterbalance the present situation where most continuing education is
through medical representatives and drug companies.
References
1.
MCI, 1997, Medical Council of India Regulations on Graduate Medical
Education, MCI, New Delhi.
2.
RGUHS 1997, Rajiv Gandhi University of Health Sciences-Kamataka,
Ordinance Governing MBBS Degree Programme, RGUHS, Bangalore.
3.
IOCU, 1988, Towards Rational Drug Use - Proceedings of the International
Consultation on Rational Drug Use in Undergraduate Medical / Pharmacy
Education, IOCU, Penang.
4.
Narayan T and Narayan R, 1993, Graduate Feedback on Medical Education
based on experience in Peripheral Health Institutions, Community Health Cell,
Bangalore.
5.
NTTC, 1989, Manual for Training on Concept of Essential Drugs and
Rationalised Drug Use, National Teachers Training Centre, JIPMER,
Pondicherry.
6.
Thomas M, 1986, Impact of Clinical Pharmacology in the Training of Physicians,
IJME, 25:2, May-Aug 1986.
7.
ICSSR and ICMR (Indian Council of Social Science Research and Indian
Council of Medical Research), 1981, Health For All - An Alternative Strategy,
Indian Institute of Education, Pune.
3
RATIONAL DRUG THERAPY (PRESCRIBERS’ LEVEL)
BE KNOWLEDGEABLE ABOUT DRUGS IN GENERAL AND THE
PARTICULAR DRUG BEING PRESCRIBED
EDUCATION, INCLUDING CONTINUING EDUCATION
BE AWARE OF THE BANNED AND HAZARDOUS DRUGS
USE ESTABLISHED DRUGS, DO NOT RUSH FOR THE LATEST
USE ONLY DRUGS INCLUDED IN THE FORMULARY
SPECIFY USAGE, DOSAGE FORM, ROUTE OF
ADMINISTRATION, QUANTITY AND DURATION OF
TREATMENT
IMPROVE PRESCRIBING HABITS, DRUGS UPDATE
ATTEND CLINICAL MEETINGS AND SEMINARS
EDUCATE THE PATIENT ON THE CORRECT USE OF THE
DRUG. IMPROVE INSTRUCTIONS ON HOW TO TAKE THE
DRUG.
BE COST CONSCIOUS
AVOID SHOTGUN THERAPY
DO NOT BE CARRIED AWAY BY THE PROMOTIONAL
ACTIVITIES OF THE FIRMS AND THEIR REPRESENTATIVES
HAVE ETHICAL CONSIDERATIONS
ADVANTAGES OF THE CONCEPT OF ESSENTIAL DRUGS
MEDICAL
MEDICALLY, THERAPEUTICALLY AND SCIENTIFICALLY SOUND
LIMITS USE OF IRRATIONAL AND HAZARDOUS DRUGS
DECREASE IATROGENESIS
IMPROVES MONITORING OF ADVERSE DRUG REACTIONS
ECONOMIC
PREVENTS WASTAGE OF SCARCE RESOURCES ON NONESSENTIALS
LARGER PRODUCTION OF PRIORITY DRUGS BRINGS DOWN
THEIR PRICES
CURTAILS AGGRESSIVE MARKETING OF NON ESSENTIALS
SOCIAL
RESPONDS TO THE REAL NEEDS OF PEOPLE
DISSEMINATION OF CORRECT INFORMATION TO MEDICAL
PERSONNEL AND CONSUMERS
MAKES IT IMPERATIVE TO DRAW UP PRIORITIES
ADMINISTRATIVE
ORGANISATIONALLY SOUND AND MAKES QUALITY CONTROL EASIER
FACILITATES THE STREAMLINING OF PRODUCTION, STORAGE AND
DISTRIBUTION OF DRUGS
HELPS IN CLEAN IDENTIFICATION OF DRUGS
FACILITATES FIXING OF PRICES AS WELL AS REVISION/WITHDRAWAL OF EXCISE
DUTIES AND SALES TAX.
”S. -'.S.
$1.
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«-*1
75*)/al
fr.li IfU'isdic
. Atrcoine sulphate {Refer Anildolesl
!. Oic/cloaia
i. FiuietLacitie (Refer Anti-Allergicsl
AMI •Al.tfXnffP.S
. OPS Pacteh Fora-ihl
(voerati
(notdeloHydrochl
r children/oride
LAXAnViS
10.?
(filer A^’.i Alhigirsl
5*9/1!
10.* 5
IO.,
O.bij/tl
*l5i/5
2*9
. Ispaghula bust
!. Paraffin, Ihiid •
Glycerine
Granules
liquid b/
S-jppositor
)
-h-
? •»
I. Frrdnjwlonr
2.
*11
Hydrtut
sch.p
(1)
G>
U) .
tirfinn succinate
r-l| t><i
*igir$)
AHU >;^<nc
1. insrha (Flair.)
Inwlu ’Until
?. bl ilrxlmde
(OU/il
(OU/al
■
8iC3 a?;k-v»jiic
I. I«ipn«i3f
2. Chlorproaiane
S. (ru:efii (Refer Cnli Epileptics)
RCbl'lKIAi
J,. Deriphylhtf
Mnnphylltae
5. Silb-daaol
*,jIGag
K-1
IGvag
2.
<• *eTerbi>lali
?.j
<•1
2.*ag
5. O'.f7'-a
• Anti-tussive
I. Codeine laosphde
j».s»
25ag/al
1 lOag/al
2S«9/al
0.5ag/a|
**
•?.?'
. Zinc 0<He *h(oi(lnl«<
. MhiUitld (oitdaenU
hmrl Beniode (etuljiool
IltoeycindKilncin
Gentiin Violet
*rrioli<e:ofl loinUenU
Penicil ins
Onaycyc1 in
Harflojicio
(6)
51,101 in 5Hal
251,501 in 25d
0.H in SOW
#.5l»$.0.tt in 5NH.
JCffal
7.51 In *110/25 i*p
2. I.V. Sadi.ua Chloride
3. I.V. Oedrose’Saline
<. I.V. Mohr l.aclde
5. I.V. *Sodiu Bicurbonile
6. Pohsdu
*
Chloride
VITAnil S/rtlNERALS
1. Ascorbic Acid
2. ViUain A
i. ViUiin 8 coaplei
SKIM I SIO
(51
(71
w
Jg/JOil Io \
IWag
IU
Tes
30000 1U
Tes
54000 lU/al
Tes
Tes
21 loinlitc
21 (olalitc
251 (eaibi .
Reader, Ola .
II soldi®
*
21 (aiabta
{Refer Anti-licteriils above)
(Refer Mi-liderids above)
<»aj
cn cp.'jfs
•WlEIJilG
* liergt
Hel
2. Oxytocin
«)
I. I.V. Dedrose
l'?«9
5. *
I-.
f
;
F
(2)
(J)
REHTORAHOM AGIO BASE ELECTROLYTE biliace
*jO.2
/al
5 lU/al
10 lU/al
Telrtcyclh?
PilocJrpine
Kuailropine
Chloriipheoicol
II (oinltenl
Il (drops)
Il (drops) {
ll (oiatieat
0.(1 (drops)
-A-
Ill
(2)
EMRGEO DRUGS
1. Oxygen cylinders on trolleys, with
(lew Beiers and task
2. Dopa.ine
J. Hydro cortisone
4. lignocaine 5. Atropine
6. Sodiua Bicarbonate
7. Fralideriae
B. Adrenaline
9. F.ephen ter tine
10. Ihnnilol
II. ,'Vgnnshi S-llphale
12. Iracbestwr set, 24, 27, 30, 34
. ACCESSORIES
ID
(41
(21
(5)
(51
4* width
H. Surgical Spirit
200ag/5il
(Refer Horiones)
11 , 21
(Refer in Antispasiodicsl
(Refer Rehydra I ion)
(Refer Antidotes)
(Refer Anti-Allergicsl
(Refer SmreUcs)
(Peter kJidotes)
1. Vater (or injection
2. *n:i/di.;g pero.ide
3. ChlorLecidine
4. Absorbent Colton
5. Sauce, stall I large
4, Bandage
7. Butterfly (scalp) venesets, 18, 21, 24
8. Sutures
Black braid'd silk - I, 1.0, 2, 2.0, J, 3.0
Kersilk - 1.0, 2.0, 1.0
Catgut, plain - 1, 1.0, 2, 2.0, 3, 3.0
Catgut, chrc.ic - I, 1.0, 2, 2.0, 3.0
Prol
Vicrylene,- al5.0,rauaati
4.0,c3.0- I, 1.0, 2.0, 3.0
Cotton thread
9. Suture Needles
10. Ilypoderiic Needles
11. Gloves, surgical, 4, 4U/2, 7
12. R>-les lubes
Catheters, Foley's, S, 12, 16, 20
21. Bleaching powder
0.5g poad./vlal
1 in 1000/11 aap
ISag/al aap
2(1 in 35011
501 in aap
VACCINES I SIRA
10.1
Aipules
61 Solution
41 W/V Liquid
2. Essential drogs in Priiary Health Care in India, Southern region list,
prepared at National Seminar conducted by NIPCCO.
3.I. lists
o( drugs received froi Government and other sources.
CHAI-CHAI (oriulary.
(61
SI.
Ko.
(II
Nau of Drug
(2)
MAESIIKI CS
I. Ether, Anaesthetic
2. Halothane
3. Ttiiopenlil
4. Nitrous Oiide
5. Oxygen
Tablets
(31
Capsule
(4)
Injections
• (51
AKflOOfES
Syruo
(61
4. Indonethac in
5. Pentazocine Lactate
3. Pethidine
MH-fllLKGiCS
.hlorpbrniranins nitrate
2. -frwUwHne
0.5, ><p
Inhalation
(Refer Emergency Drugs)
W0»g.
300>g
2ODi
(GOagq
>
300ag.Z2al.aap
125q/5il
J0ag/a|
SO.g/al
4ag
ICug
25.,
Sq/Sal
1 in 1000, hl up
4. Deianellusvne
Xag/al, 2al vial
Anli-hehinlhic
1. Nebendazole
Anti-aioebic
1. Kelronidazole
1. Dapsone
Sig/al
SOag/al
2ag/5tl '
lOOnj/dal
2. lifaapicin
J. Chhaiainc
(61
(71
(g/IOil (pc»
lOOng
lOOag/Sal
200ag
<00sg
lOOig/Sil
500000U/via!
al
400000(J/
»
i
a
l
2000000U/rla|
iOOOOOU/Tial
12000WU/»viiaall
2400000U/
IOOOOOOU/vI
2. Procaine Pencil 1 In
4. tetracycline
5. Doxycycline
6. Chloratphenico1
7. Co-lrinoxazole
8. Irylhroeycin
1. Aeoiycil in
ID. Aepicil in
(51
0.5g pond. In vial
1
250ag
100ag
250ag
Ig/Ylal
250tg
23.,
250ig/rial
t.ao.j.sjw.,
250ng
A-uiirrcMr
200.g/al
-.j*glO
lOOn]
lOvxg
w>2
141
0.6«g/«l
3. Benzathine Pencil in
xs.,
ZS-,
(3)
1. Atropine sulphate
2. Nagnesiua Sulphate
3. Pralidotiit
AMII-IXfCCriVlS
Anti bacterial
1. Benzyl Pencil 1 in
3. Adrenaline
MH-VILEPHC3
1. Pbetobarbilone
2. Diatepan
3. fhro/t n Sodiua
4. Carbataupine
a. r*
Others
(71
Inhalation'
Inhalation
MVjESIC/AXHPYREnCS
I. Poracelaeol
2. Aspirin
3. Ibuprofen
(21
(II
£SSEHIIAl DRUGS LIST . Prepared bv Conrnunltv Health Cell for
25ag
50ag
IWnj
ISOng
JOOag
50ag
tOO.g
■2-
iOOag/Yial
l50ig/5nl
t.<0>]>5.2W>,/5.l
I25ig/3«l
I25ij/5al
I25ng/5a|
(21
Aftti-hyc»rtensive
1. H/drochlorolhiat ide
2. Feserpire
J. Hydralazine
<. Aknnhl
Gl
■1>
(1)
(?)
MH-TUBEKU.K
1. Itt
2. Streptoaycin
3. Thioacetaione
1. Rihnplcio
5. Ethaabulol
(3)
10
(5)
(6)
IOO.j
Ighlal
irieHttreatment
see Xatiofonallubercol
Tubercnl
osis)osis Control Pregraaae & binned coibinations in the
AHII-FIlARIAL
5*^
6r iseofulin
t aphuter kin 1
AXI1-MALARIAL
IZS.g
ChloroQuin
Priaaqtila
SulfadoxiaiPyreaelhaaine
Ovinine Sulphate
KAEnOPDIEUC
itfq base
J.Sog
S.500igip.25»j
JW.g
Ferrous Sulptate»Folic Acid
Ferron? fuiarale»Folic Acid
Folic Acid
CARDIOVASCULAR
Anti-anginal
Isosorbide Nitrate
Proprannlnl
*90.5
gl*5»2.G 'i«g
5*1
l20»g/5»l
50ag/vlal
IO«g
K-ag
<0.,
AOag/al
300ag/aip
(5)
(&)
X
5;»g
O.l«g
?5»g
-*
Cardiac glrcnside
1. Digmia
0IUPE1IC5
ISCig
liefer Anti-leprosy)
2W«g
h-elhfl carbuatine
AXlI-FlWGAl
(71
(41
1. frvseaide
2. Goironolaclone
j. Ranaitcl
GAJIRO IxfV5IIIW,
AnUcidl
!. filuiiriii'i Hrdro'ide
I. Pignewn Irinlicate
J. F.anitidine
Anti *eaetict
1. He Ioc1 opr a»i de
o.:r.»g . .
0.2S«g/tl
dag
25 «g
lOag/al
2vt iai>»iU
2rZaq
!•*»,
75.J/1I
14.;
Sog/al
t.
(Fefer Anti Allergm)
AMi ?fu
*io<li(
1. Atropine inlpbale (Refer Anildoletl
2. Dicycloain
J. Fivietka.-ii P (Refer Anti-Allergic?)
O.Seg
If.;
Sag/Sol
O.hg/al
N
Asn •ot.w.wfP.i
-
l. 0P3 Paclth ?Wi) Forauh)
2. l'.'0?ra«i
uride
(notdehrl /dichiochlldren)
lAtAI VES
‘M
1. Ispaghula tusk
2. Fariffin, liquid '
5. Glycerine
Granules
liquid b/
Suppository
m
)
-Lt-
<2>
(II
<i>
I. frednrwlonr
I. I.V. Dextrose
HydruHtiWir svdi'«a s^'.cinate
If*;.., r-H itsj.^ir,}
AT. 11 K-MI1C
2. I.V. Sodiua Chloride
i. I.V. DeitrosnSiline
4. I.V. Ihlar Lactate
5. I.V. Sodiua Bicarbonate
6. Polasshi Chloride
viiAnnis/niNERAis
2.
3. E
*
1. in*rli» (Haiti!
Invilu ‘.Lente!
*. GIil-rfrc>i*ide
(OU/il
(OU/il
-
. Ascorbic Acid
2. Vitaiin A
. Vitaiin B coiplex
SI.IN 1 SIS
?>»C5i ntjvcjjiic
I. *[itpraua
2. Chlorjrcurinr
lOag
5. Guztpi (Refer Anti -Epilephcs)
RrylKIAi
1.
&prifhyllt»f
IWig
2. Aitnoptylliae
P/Cig
3.
2<J
Slitr/t?M-I
TrrfoUliif
4q
92.* 5
llOig/il
*925/11
I. felbrrgh
2. Qiylocin
6Q»g/5il
Zij/511
0.519/.I
liihihlina
5.
* Anil-insure
I. Codeine fiosphilr
OWlEIHG
e
■•.i
(2)
(JI
REHTDRATION AGIO BASE ELECTROLYTE balance
. line 0<ide *<toi<Unli
Vhitlield (oiaUinll
Pe'i yl Benioile (eiukion)
l eoiycifti Bacitracin
Gentian Violet
Kicomznle (ointienll
Penicil ins
Ooiycyclia
Nordoaacin
(0
U!
(51
(71 J
51,101 in SMii
251,501 in 2511
O.H in 50011
D.5HS.O.9I in 5Wd
SCflT.l
7.51 in IOal/2511 aap
Jg/JOi! (a
lOOig
W->) IU
Tes
5C000 IU
Tes
50000 lU/il
Tes
Tes
21 (oiaUet
21 (olatiec.
251 (etolsl . ,
Pcvder, Oh .
II sohlioa :
21 (aiitien
(Refer Anti
*lacterials above!
{Refer Anli-laclerials above!
* j
WO
c?e cm
>i;j
0.2ig/il
5 tU/il
10 IU/11
lelrecyc lh*
Pilocarpine
Hviatropine
Chloraiphenicol
•
-b-
II (ointient ■ •
ll (drops) j
Il (drops)
ll (oiahenl r’i
O.U (drops) fx
(51
(I)
(4)
(7>
EHCRGEHCT DRUGS
I. Oxrgen cylinders on trolleys, with
Hex «eters and *ask
2. Dopasine
J. Hydro cortisone
4, Lignocaine .
5. Atropine
6. Srdiua Bicarbonate
7. Fralideriae
8. Adrenaline
*?. Kephenleraine
10. Hannitol
II. Ibgnetfaa sulphite
12. Irad.e-.l(.«r set, 24, 27, 30, 34
. ACCESSORIES
200ag/5a!
(Refer Horeones)
Il , 21
(Refer in Antispasiodics)
(Refer Rehydration)
(Refer Antidotes)
(Refer Anti-Allergies)
(Refer Pi-irelics)
(3eler Antidotes)
I. Vater (or injection
2. *nr.l]/di. peroxide
3. Chlorheiidine
4. Absorbent Cotton
5. Saute, stall I large
6. Bandage
7. Butterfly (scalp) tenesels, 18, 21, 24
8. Sutures
Black braided silk - I, 1.0, 2, 2.0, 3, 3.0
Kersill - 1.0, 2.0, 4.0
Catgut, plait - 1, 1.0, 2, 2.0, 3, 3.0
Catgut, chrcilc - I, 1.0, 2, 2.0, 3.0
Prol
Vicrylene,- atraueal
5.0, 4.0,ic3.0- I, 1.0, 2.0, 3.0
Colton thread
5. Suture Keedles
10. Ilypoderaic Needles
II. Gloves, surgical, 4, 611/2, 7
12. Ryles lubes
0.5g pond./vial
1 in 1000/al aep
15*g/il aep
2(1 In 350
*1
SOL in aep
Aapules
61 Solution
41 W/V Liquid
ESSENTIAL DRUG LIST
(PREPARED BY COMMUNITY HEALTH CELL)
SI.
No.
Name of Drug
1.
2.
3.
4.
5.
ANAESTHETICS
Ether
Halothene
Thiopental
Nitrous Oxide
Oxygen
1.
2.
3.
4.
ANTI - ALLERGICS
Chlorpheniramine maleate
Promethazine
Adrenaline
Dexamethasone
1.
2.
3.
ANTIBODIES
Atropine sulphate
Magnesium Sulphate
Pralidoxime
1.
2.
3.
ANTI - LEPROSY
Dapsone
Rifampicin
Clofgzimine
SI.
No.
Name of Drug
1.
2.
3.
4.
ANALGESIC/ANTIPYRETICS
Paracetamol
Aspirin
Ibuprofen
Indomethacin
Pentazocine Lactate
Pethidine
ANTI - EPILEPTICS
Phenobarbitone
Diazepam
Phenytoin Sodium
Carbamazepine
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
ANTI - INFECTIVES
Mebendazole
Metronidazole
Benzyl Pencillin
Procaine Pencillin
Benzathine Pencillin
Tetracycline
Doxycycline
Chloramphenicol
Co-trimoxazole
Erythromycin
Amoxycillin
Ampicillin
1.
2.
3.
4.
5.
ANTI - TUBERCULAR
INH
Streptomycin
Thioacetazone
Rifampicin
Ethambutol
1.
2.
3.
4.
5.
6.
1.
ANTI - FILARIAL
Di-ethyl carbamazine
1.
2.
J.
4.
ANTI - MALARIAL
Chloroquin
Primaquin
Sulfadoxin Pyremethamine
Quinine Sulphate
1.
2.
CARDIOVASCULAR
Isosorbide Nitrate
Propranolol
1.
CARDIAC GLYCOSIDE
Digoxin
1.
2.
3.
GASTRO INTESTINAL
Antacids
Aluminium Hydroxide
Magnesium Trisilicate
Ranitidine
1.
2.
Anti-emetics
Metoclopramide
Promethazine
1.
2.
3.
Anti spasmodic
Atropine sulphate
Dicyclomin
Promethazine
Anti -Diarrhoeals
ORS packets
Loperamide Hydrochloride
(not for children)
ANTI - FUNGAL
Griseofulvin
Amphotericin B
1.
2.
3.
HAEMOPOIETIC
Ferrous Sulphate + folic Acid
Ferrous Fumarate + folic Acid
Folic Acid
1.
2.
3.
4.
ANTI - HYPERTENSIVE
Hydrochlorothiazide
Reserpine
Hydralazine
Atenlol
1.
2.
3.
DIURETICS
Frusemide
Spiranolactone
Mannitol
1.
2.
3.
LAXATIVES
Isapaghula husk
Paraffin, liquid
Glycerine
1.
2.
HARMONES
Prednisolone
Hydrocortisone sodium succinate
1.
2.
3.
PSYCHO THERAPEUTIC
Imipramine
Chlorpromazine
Diazepam
1.
2.
OBSTETRICS
Methergin
Oxytocin
1.
2.
3.
VITAMINS / MINERALS
Ascorbic Acid
Vitamin A
Vitamin B complex
1.
2.
3.
ANTI DIABETIC
Insulin (plain)
Insulin (Lente)
Glibenclamide
1.
2.
3.
4.
5.
RESPIRATORY
Anti asthmatic
Deriphylline
Aminophylline
Salbutamol
Terbutaline
Oxygen
1.
Anti-tussive
Codeine Phosphate
1.
2.
3.
4.
5.
6.
REHYDRATION ACID BASE
ELECTROLYTE balance
I.V. Dextrose
I.V. Sodium Chloride
I.V. Dextrose + Saline
I.V. Molar Lactate
I.V. Sodium Bicabonate
Potassium Chloride
1.
2.
3.
4.
5.
6.
7.
8.
9.
SKIN & STD
Zinc Oxide Ointment
Whitfield ointment
Benzyl benzate
Neomycin+bacitracin
Gention violet
Miconazole ointment
Pencillin
Doxycyclin
Norfloxacin
1.
2.
3.
4.
EYE DROPS
Tetracycline
Pilocarpine
Humatropine
Chloramphenical
1.
2.
3.
4.
5.
6.
7.
8.
ACCESSORIES
Water for injection
Hydrogen peroxide
Chlorhexidine
Absorbent Cotton
Gauze, small & large
Bandage
Butterfly (scalp) venesets 18,21,24
Sutures
Black braided silk
Mersilk
Catgut, plain
Catgut Chromic
Prolene, atraumatic
Vicryl
Cotton thread
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Suture Needles
Hypodermic Needles
Gloves, surgical
Ryles Tubes
Adhesive Plaster
Elastocrepe bandage
Plaster of Paris
Surgical Spirit
Drip set: administration; fluid, bloc
Cannula, IV for venesection
Syringes
Catheters, plain
Catheters, Foley’s
Bleaching powder
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11
12.
13.
EMERGENCY DRUGS
Oxygen cylinders on trolleys, with
flow meters and mask
Dopamine
Hydro cortisone
Lignocaine
Atropine
Sodium Bicarbonate
Pralidoxime
Adrenaline
Mephentermine
Mannitol
Magnesium sulphate
Trachestomy set, 24,27,30,36
1.
2.
3.
4.
VACCINES & SERA
All vaccines as per National
Universal Immunization Programme
Anti Rabies serum
Anti Snake Venom Serum
DIAGNOSTIC AGENTS
As needed
This list has been prepared using the following lists for reference:
1.
2.
model list of essential list
Essential drugs in Primary Health Care in India, Southern region list, prepared at
National Seminar conducted by NIPCCD.
3. Lists of drugs received from Government and other sources
4. CHAI-CMAI formulary.
Volume 13, Number 4. 1999
World Health Organization, Geneva
WHO Drug information
Contents
Regulatory and Safety Matters
General Policy Issues
Access to essential drugs
217
WHO's role in ensuring access to essential
drugs
217
Access to medicines: an urgent need for
solutions
220
Amsterdam statement on access to medicines 223
Reports on Individual Drugs
Influenza preparedness plan: antiviral drugs
Atovaguone and proguaml hydrochloride:
a new antimalarial combination
225
226
Current Topics
Roll Back Malaria
The Medicines for Malaria Venture (MMV)
The Japanese alliance
A new antimalarial donation programme
Roll Back Malaria in Europe
The WHO Antimicrobial Resistance
Information Bank
228
228
228
229
229
230
Vaccines and Biomedicines
Quality assurance and safety of
biologicals
Influenza preparedness plan: vaccine
production and availability
Thiomersal: theoretical risk leads to
phasing out
Leflunomide: pancytopenia and skin reactions
Didanosine and pancreatitis
Sertraline for post-traumatic stress disorder
Pemoline withdrawal following liver
complications
Levetiracetam: new drug for epilepsy
Methotrexate: monitoring essential
Methotrexate: care in prescribing
Grepafloxacm withdrawal: severe
cardiovascular events
Reteplase incompatible with heparin
Postmarketing system to be revised
Abacavir: hypersensitivity reactions
Initiative to curb illegal sale of drugs over
the Internet
Unapproved HIV test kits available on
the Internet
V-King®: unapproved use of sildenafil
Miralex® undeclared corticosteroid
Rules for dietary supplements finalized
238
238
238
238
239
239
239
239
239
240
240
240
240
241
241
241
ATC/DDD Classification
Temporary list
242
Final list
245
Essential Drugs
231
235
237
WHO Model List (revised December 1999)
249
Proposed International
Nonproprietary Names: List 82 263
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
WHO Model List (revised December 1999)
injection for spinal anaesthesia,
0.5% (hydrochloride) in 4-ml ampoule
to be mixed with 7.5% glucose solution
Section 1: Anaesthetics
1.1
GENERAL ANAESTHETICS AND OXYGEN
ether, anaesthetic (1c) (2)
inhalation
halothane (2)
inhalation
ketamine (2)
injection. 50 mg (as hydrochloride)/ml in 10-ml vial
nitrous oxide (2)
"thiopental (2)
injection for spinal anaesthesia,
5% (hydrochloride) in 2-ml ampoule
to be mixed with 7.5% glucose solution
inhalation
topical forms, 2-4% (hydrochloride)
powder for injection. 0.5 g, 1.0 g
(sodium salt) in ampoule
LOCAL ANAESTHETICS
“bupivacame (2. 9)
injection, 0.25%. 0.5%
(hydrochloride) in vial
injection, 1%. 2%
(hydrochloride) in vial
injection, 1%, 2% (hydrochlonde)
+ epinephrine 1:200 000 in vial
inhalation (medicinal gas)
oxygen
1.2
"lidocaine
dental cartridge, 2% (hydrochloride)
+ epinephrine 1:80 000
Complementary drug
injection. 30 mg
ephedrine (C)
(For use in spinal anaesthesia
(hydrochloride)/m! in
dunng delivery to prevent hypotension)
1 -ml ampoule
" Example of a therapeutic group. Various drugs can serve as alternatives.
Explanatory Notes
When the strength of a drug is specified in terms of a
selected salt or ester, this is mentioned in brackets: when it
refers to the active moiety, the name of the salt or ester in
brackets is preceded by the word "as".
Many drugs included in the list are preceded by a box (°) to
indicate that they represent an example of a therapeutic
group and that various drugs could serve as alternatives. It
is imperative that this is understood when drugs are selected
at national level, since choice is then influenced by the
comparative cost and availability of equivalent products.
Examples of acceptable substitutions include:
° Hydrochlorothiazide: any other thiazide-type diuretic cur
rently in broad clinical use.
° Hydralazine: any other peripheral vasodilator having an
antihypertensive effect.
° Senna: any stimulant laxative (either synthetic or of plant
origin).
° Sulfadiazine: any other short-acting, systemically active
sulfonamide unlikely to cause crystalluria.
United Nations Convention against Illicit Traffic in Narcotic
Drugs and Psychotropic Substances (1988).
(2)
Specific expertise, diagnostic precision, individualization
of dosage or special equipment required for proper use.
(3)
Greater potency or efficacy.
(4)
In renal insufficiency, contraindicated or dosage adjust
ments necessary.
(5)
To improve compliance.
(6)
Special pharmacokinetic properties.
(7)
Adverse effects diminish benefit/risk ratio.
(8)
Limited indications or narrow spectrum of activity.
(9)
For epidural anaesthesia.
(10)
Sustained-release preparations are available. A pro
posal to include such a product in a national list of essential
drugs should be supported by adequate documentation.
(11)
Monitonng of therapeutic concentrations in plasma can
improve safety and efficacy.
Letters in parentheses following the drug names indicate the
reasons for the inclusion of complementary drugs:
(A)
When drugs in the main list cannot be made available.
(B)
When drugs in the main list are known to be ineffective or
inappropriate for a given individual.
Numbers in parentheses following drug names indicate:
(C)
For use in rare disorders or in exceptional circumstances.
(1)
Drugs subject to international control under: (a) the (D)
Reserve antimicrobials to be used only when there is
Single Convention on Narcotic Drugs (1961); (b) the Con
significant resistance to other drugs on the list.
vention on Psychotropic Substances (1971); or (c) the
Drugs are listed in alphabetical order.
249
Essential Drugs
1.3
WHO Drug Information Vol. 13, No. 4, 1999
PREOPERATIVE MEDICATION & SEDATION 2.4
DISEASE-MODIFYING AGENTS USED
FOR SHORT-TERM PROCEDURES
IN RHEUMATIC DISORDERS
injection, 1 mg (sulfate)
in 1-ml ampoule
atropine
chloral hydrate
syrup, 200 mg/5 ml
"diazepam (1b)
injection, 5 mg/ml
in 2-ml ampoule
tablet, 5 mg
injection, 10 mg (sulfate or
hydrochloride) in 1-ml ampoule
"morphine (1a)
azathioprine (2)
tablet, 50 mg
chloroquine (2)
tablet. 100 mg, 150 mg
(as phosphate or sulfate)
tablet, 25 mg
cyclophosphamide (2)
methotrexate (2)
tablet, 2.5 mg (as sodium salt)
penicillamine (2)
capsule or tablet, 250 mg
sulfasalazine (2)
tablet, 500 mg
elixir or syrup, 5 mg
(hydrochloride)/5 ml
"promethazine
Section 2: Analgesics, Antipyretics,
Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs), Drugs Used to
Treat Gout and Disease-Modifying
Agents used in Rheumatic
Disorders (DMARDs)
2.1 NON-OPIOID ANALGESICS & NSAIDs
Section 3: Antiallergics and
Drugs Used in Anaphylaxis
tablet. 4 mg (hydrogen maleate)
"chlorphenamine
injection. 10 mg (hydrogen
maleate) in 1-ml ampoule
"dexamethasone
tablet. 500 pg. 4 mg
injection. 4 mg
dexamethasone phosphate
(as disodium salt) in 1-ml ampoule
epinephrine
injection. 1 mg (as hydrochlonde or hydrogen tartrate)
in 1-ml ampoule
hydrocortisone
powder for injection, 100 mg
(as sodium succinate) in vial
"prednisolone
tablet, 5 mg
tablet. 100-500 mg
acetylsalicylic acid
suppository, 50-150 mg
"ibuprofen
tablet. 200 mg. 400 mg
tablet. 100-500 mg
paracetamol
suppository. 100 mg
syrup. 125 mg/5 ml
2.2
OPIOID ANALGESICS
"codeine (1a)
tablet, 30 mg (phosphate)
"morphine (1a)
injection, 10 mg (sulfate or
hydrochloride) in 1-ml ampoule
oral solution, 10 mg (hydrochloride
or sulfate))/5 ml
tablet, 10 mg (sulfate)
4.1
NON-SPECIFIC
"charcoal, activated
ipecacuanha
injection, 50 mg
(hydrochloride) in 1-ml ampoule
4.2 SPECIFIC
atropine
tablet, 50 mg, 100 mg (hydrochloride)
2.3
DRUGS USED TO TREAT GOUT
allopurinol (4)
tablet, 100 mg
colchicine (7)
tablet. 500 pg
calcium gluconate (2, 8)
deferoxamine
° Example of a therapeutic group. Various drugs can serve as alternatives.
250
powder
syrup, containing 0.14% ipecacuanha
alkaloids calculated as emetine
acetylcysteine
Complementary drug
"pethidine (A) (1a, 4)
Section 4: Antidotes and Other
Substances Used in Poisonings
injection, 200 mg/ml
in 10-ml vial
injection, 1 mg (sulfate)
in 1-ml ampoule
injection, 100 mg/ml
in 10-ml ampoule
powder for injection, 500 mg
(mesilate) in vial
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
dimercaprol (2)
injection in oil, 50 mg/ml
in 2-ml ampoule
°Di-methionine
tablet, 250 mg
injection, 10 mg/ml
in 10-ml ampoule
methylthioninium chlonde
(methylene blue)
injection, 400 pg (hydrochloride)
in 1-ml ampoule
naloxone
capsule or tablet, 250 mg
penicillamine (2)
potassium ferric hexacyanoferrate(ll) 2H2O (Prussian blue)
sodium calcium edetate (2)
powder for oral
administration
injection, 200 mg/ml
in 5-ml ampoule
sodium nitrite
injection, 30 mg/ml
in 10-ml ampoule
sodium thiosulfate
injection. 250 mg/ml
in 50-ml ampoule
Section 6: Anti-infective Drugs
6.1
ANTHELMINTHICS
INTESTINAL ANTHELMINTHICS
6.1.1
albendazole
chewable tablet. 400 mg
levamisole
tablet, 50 mg, 150 mg
(as hydrochloride)
“mebendazole
chewable tablet. 100 mg, 500 mg
chewable tablet. 500 mg
niclosamide
praziquantel
tablet, 150 mg, 600 mg
pyrantel
chewable tablet, 250 mg
(as embonate)
oral suspension. 50 mg
(as embonate)/ml
6.1.2
ANTIFILARIALS
tablet, 50 mg, 100 mg
(dihydrogen citrate)
diethytcarbamazine
Section 5: Anticonvulsants/
Antiepileptics
ivermectin
carbamazepine (10, 11) scored tablet. 100 mg, 200 mg
suramin sodium (8) (2. 7)
“diazepam (1b)
injection, 5 mg/ml in 2-ml
ampoule (intravenous or rectal)
ethosuximide
Complementary drug
6.1.3
capsule, 250 mg
magnesium sulfate
phenobarbital (1b. 11)
scored tablet. 3 mg. 6 mg
powder for injection,
1 g in vial
ANTISCHISTOSOMALS AND OTHER
ANTITREMATODE DRUGS
syrup, 250 mg/5 ml
praziquantel
tablet. 600 mg
injection, 500 mg/ml
in 2-ml ampoule
and 10-ml ampoule
triclabendazole
tablet, 250 mg
Complementary drug
capsule. 250 mg
oxammquine (C) (8)
tablet. 15-100 mg
syrup, 250 mg/5 ml
elixir, 15 mg/5 ml
phenytoin (7.11)
capsule or tablet.
25 mg. 50 mg, 100 mg (sodium salt)
injection. 50 mg
(sodium salt)/ml in 5-ml vial
valproic acid (7.11)
BETA LACTAM DRUGS
“amoxicillin
capsule or tablet. 250 mg.
500 mg (anhydrous)
powder for oral suspension,
125 mg (anhydrous)/5 ml
enteric coated tablet.
200 mg, 500 mg (sodium salt)
Complementary drug
“clonazepam (B) (1b)
6.2 ANTIBACTERIALS
6.2.1
ampicillin
powder for injection. 500 mg.
1 g (as sodium salt) in vial
benzathine
benzylpenicillin
powder for injection.
1.44 g benzylpenicillin
(= 2.4 million IU) in 5-ml vial
benzylpenicillin
powder for injection.
600 mg (= 1 million IU),
3 g (=5 million IU)
(sodium or potassium salt) in vial
scored tablet. 500 pg
“ Example of a therapeutic group. Various drugs can serve as alternatives.
251
Essential Drugs
“cloxacillin
WHO Drug Information Vol. 13, No. 4, 1999
capsule, 500 mg, 1 g (as sodium salt)
“metronidazole
tablet, 200-500 mg
powder for oral solution, 125 mg
(as sodium salt)/5 ml
injection. 500 mg in 100-ml vial
suppository, 500 mg, 1 g
powder for injection, 500 mg
(as sodium salt) in vial
phenoxymethylpenicillin
tablet, 250 mg
(as potassium salt)
powder for oral suspension, 250 mg
(as potassium salt)/5 ml
procaine benzylpenicillin
powder for injection.
1 g (= 1 million IU),
3 g (= 3 million III) in vial
oral suspension, 200 mg
(as benzoate)/5 ml
tablet, 250 mg. 500 mg
nalidixic acid (8)
nitrofurantoin (4, 8)
tablet. 100 mg
spectinomycin (8)
powder for injection. 2 g
(as hydrochloride) in vial
tablet, 500 mg
“sulfadiazine (4)
injection. 250 mg (sodium salt)
in 4-ml ampoule
Restricted indications
“amoxicillin +
“clavulanic acid (D)
tablet. 500 mg + 125 mg
ceftazidime (D)
powder for injection, 250 mg
(as pentahydrate) in vial
'ceftriaxone (D)
powder for injection. 250 mg
(as sodium salt) in vial
imipenem +
ciiastatin (D)
powder for injection. 250 mg
(as monohydrate) + 250 mg.
(as sodium salt)
500 mg (as monohydrate) +
500 mg in vial (as sodium salt)
“sulfamethoxazole +
trimethoprim (4)
oral suspension,
200 mg + 40 mg/5 ml
injection, 80 mg + 16 mg/ml
in 5-ml and 10-ml ampoule
injection, 20 mg/ml
in 5-ml ampoule
Complementary drugs
chloramphenicol (C)
capsule, 250 mg
oral suspension. 150 mg
(as palmitate)/5 ml
powder for injection, 1 g
(sodium succinate) in vial
'ciprofloxacin
tablet, 250 mg
(as hydrochloride)
'doxycycline (5, 6)
capsule or tablet,
100 mg (hydrochloride)
'erythromycin
capsule or tablet, 250 mg
(as stearate or ethyl succinate)
powder for oral suspension, 125 mg
(as stearate or ethyl succinate)
powder for injection, 500 mg
(as lactobionate) in vial
'gentamicin (2, 4, 7, 11)
injection, 10 mg, 40 mg
(as sulfate )/ml in 2-ml vial
tablet. 100 mg, 200 mg
tnmethoprim (8)
6.2.2 OTHER ANTIBACTERIALS
“chloramphenicol (7)
tablet. 100 mg + 20 mg,
400 mg + 80 mg
oily suspension for injection,
0.5 g (as sodium succinate)/ml
in 2-ml ampoule
clindamycin (B) (8)
capsule, 150 mg
injection, 150 mg
(as phosphate)/ml
Restricted indications
vancomycin (D)
powder for injection 250 mg (as
hydrochloride) in vial
6.2.3 ANTILEPROSY DRUGS
capsule, 50 mg, 100 mg
clofazimine
dapsone
tablet, 25 mg, 50 mg, 100 mg
rifampicin
capsule or tablet, 150 mg. 300 mg
6.2.4 ANTITUBERCULOSIS DRUGS
ethambutol (4)
isoniazid
isoniazid + ethambutol (5)
“ Example of a therapeutic group. Various drugs can serve as alternatives.
252
tablet. 100-400 mg
(hydrochloride)
tablet. 100-300 mg
tablet, 150 mg + 400 mg
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
tablet, 400 mg
pyrazinamide
capsule or tablet, 150 mg, 300 mg
rifampicin
rifampicin +
isoniazid (5)
6.4.2
ANTIRETROVIRAL DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
tablet, 60 mg + 30 mg, 150 mg + 75 mg,
300 mg+ 150 mg
nevirapine (8)
tablet, 60 mg + 60 mg, 150 mg + 150 mg
(for intermittent use 3 times weekly)
zidovudine (8)
tablet. 200 mg
oral solution, 50 mg/5 ml
capsule, 100 mg, 250 mg
tablet.
60 mg + 30 mg + 150 mg,
150 mg + 75 mg + 400 mg
injection, 10 mg/ml in 20-ml vial
tablet. 150 mg + 150 mg + 500 mg
(for intermittent use 3 times weekly)
Drugs for treatment of HIV/AIDS include nucleoside
reverse transcriptase inhibitors (NRTIs), non-nucleoside
reverse transcriptase inhibitors (NNRTIs) and protease
inhibitors (Pls). Zidovudine and nevirapine have been
shown to reduce or prevent mother-to-child transmission
of HIV infection. This is the only indication for which
they are included here. Single drug use with zidovudine,
except in pregnancy, is now regarded as obsolete be
cause of the development of resistance. Triple therapy is
beyond the budgets of most national drug programmes
and therefore HIV/AIDS treatment policies must be de
cided at country or institutional level.
rifampicin + isoniazid +
pyrazinamide (5)
tablet, 150 mg + 75 mg +
400 mg + 275 mg
rifampicin + isoniazid +
pyrazinamide + ethambutol
powder for injection,
1 g (as sulfate) in vial
streptomycin (4)
Complementary drug
tablet. 50 mg + 100 mg,
150 mg+ 300 mg
thioacetazone +
isoniazid (A) (5, 7)
Additional reserve antituberculosis drugs for the treat
ment of drug-resistant tuberculosis should be used in
specialized centres only with WHO-recommended TB
control strategy, DOTS, and treatment programmes.
oral solution, 50 mg/5 ml
6.5
ANTIPROTOZOAL DRUGS
6.5.1
ANTIAMOEBIC AND ANTIGIARDIASIS
DRUGS
tablet, 500 mg (furoate)
“ diloxanide
6.3
amphotericin B (4)
tablet. 200-500 mg
“metronidazole
ANTIFUNGAL DRUGS
powder for injection. 50 mg in vial
injection. 500 mg in 100-ml vial
capsule. 50 mg
oral suspension, 200 mg
(as benzoate)/5 ml
“fluconazole
injection. 2 mg/ml in vial
oral suspension. 50 mg/5-ml
gnseofulvm (7)
capsule or tablet, 125 mg, 250 mg
6.5.2
ANTILEISHMANIASIS DRUGS
“meglumine antimoniate
injection.
30%. equivalent to approx.
8.5% antimony, in 5-ml ampoule
tablet. 100 000. 500 000 IU
nystatin
lozenge, 100 000 IU
pentamidine (5)
pessary, 100 000 IU
powder for injection, 200 mg.
300 mg (isetionate) in vial
Complementary drug
Complementary drugs
flucytosine (B) (4. 8)
capsule. 250 mg
powder for injection.
50 mg in vial
amphotericin B (B) (4)
infusion, 2.5 g in 250 ml
potassium iodide (A)
saturated solution
6.5.3
ANTIMALARIAL DRUGS
(a) FOR CURATIVE TREATMENT
6.4
ANTIVIRAL DRUGS
6.4.1
ANTIHERPES DRUGS
aciclovir (8)
“chloroquine
tablet, 200 mg
powder for injection, 250 mg
(as sodium salt) in vial
tablet. 100 mg, 150 mg
(as phosphate or sulfate)
syrup, 50 mg
(as phosphate or sulfate)/5 ml
injection, 40 mg (as hydro
chloride, phosphate or sulfate)/ml
in 5-ml ampoule
“ Example of a therapeutic group. Various drugs can serve as alternatives.
253
Essential Drugs
WHO Drug Information Vol. 13. No. 4, 1999
primaquine
tablet, 7.5 mg, 15 mg
(as diphosphate)
tablet, 300 mg (as bisulfate or sulfate)
. “quinine
injection. 300 mg (as dihydrochloride)/ml
in 2-ml ampoule
benznidazole (7)
tablet, 100 mg
nifurtimox (2, 8)
tablet. 30 mg, 120 mg. 250 mg
6.6 INSECT REPELLENTS
topical solution, 50%, 75%
diethyltoluamide
Complementary drugs
“doxycycline (B) (/or use only in
capsule or tablet,
combination with quinine)
100 mg (hydrochloride)
mefloquine (B)
(b) AMERICAN TRYPANOSOMIASIS
tablet, 250 mg (as hydrochlonde)
tablet, 500 mg + 25 mg
“sultadoxine +
pyrimethamine (B)
Restricted indications
artemetner (D)
injection, 80 mg/ml
in 1-ml ampoule
artesunate (D)
tablet, 50 mg
Section 7: Antimigraine Drugs
7.1 FOR TREATMENT OF ACUTE ATTACK
acetylsalicylic acid
tablet, 300-500 mg
ergotamine (1c) (7)
tablet, 1 mg (tartrate)
tablet. 300-500 mg
paracetamol
7.2 FOR PROPHYLAXIS
tablet. 20 mg. 40 mg
(hydrochloride)
“propranolol
(b) FOR PROPHYLAXIS
chloroquine
tablet, 150 mg
(as phosphate or sulfate)
syrup. 50 mg (as phosphate
or sulfate)/5 ml
doxycycline
capsule or tablet,
100 mg (hydrochloride)
mefloquine
tablet, 250 mg (as hydrochlonde)
proguanil (for use only in
combination with chloroquine)
tablet, 100 mg
(hydrochlonde)
Section 8: Antineoplastic and
Immunosuppressive Drugs and
Drugs Used in Palliative Care
8.1 IMMUNOSUPPRESSIVE DRUGS
Adequate resources and specialist oversight are a pre
requisite tor the introduction of this class of drugs.
tablet. 50 mg
“azathioprine (2)
6.5.4 ANTIPNEUMOCYSTOSIS AND
ANTITOXOPLASMOSIS DRUGS
pentamidine (2)
tablet. 200 mg, 300 mg
pyrimethamine
tablet. 25 mg
sulfamethoxazole
trimethopnm
injection, 80 mg + 16 mg/ml
in 5-ml and 10-ml ampoule
6.5.5 ANTITRYPANOSOMAL DRUGS
(a) AFRICAN TRYPANOSOMIASIS
melarsoprol (2)
injection, 3.6% solution
pentamidine (2)
powder for injection, 200 mg,
300 mg (isetionate) in vial
suramin sodium
powder for injection, 1 g in vial
powder for injection, 100 mg
(as sodium salt) in vial
concentrate for injection.
50 mg/ml in 1-ml ampoule
8.2 CYTOTOXIC DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
asparaginase (2)
bleomycin (2)
calcium folinate (2)
Complementary drug
eflornithine (C)
powder for injection,
10 000 IU in vial
powder for injection, 15 mg
(as sulfate) in vial
tablet, 15 mg
injection, 3 mg/ml in 10-ml ampoule
injection. 200 mg (hydrochloride)/ml in 100-ml bottles
chlorambucil (2)
tablet, 2 mg
chlormethine (2)
powder for injection, 10 mg
(hydrochloride) in vial
° Example of a therapeutic group. Various drugs can serve as alternatives.
254
capsule, 25 mg
“ciclosporin (2)
(for organ transplantation)
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
powder for injection,
10 mg, 50 mg in vial
cisplatin (2)
cyclophosphamide (2)
tablet, 25 mg
Section 9: Antiparkinsonism Drugs
“biperiden
tablet, 2 mg (hydrochloride)
injection, 5 mg (lactate)
in 1-ml ampoule
powder for injection,
500 mg in vial
cytarabine (2)
powder for injection,
100 mg in vial
dacarbazine (2)
powder for injection,
100 mg in vial
daunorubicin (2)
powder for injection.
50 mg (as hydrochloride) in vial
dactinomycin (2)
powder for injection
500 pg in vial
’doxorubicin (2)
etoposide (2)
fluorouracil (2)
evamisole (2)
mercaptopurine (2)
methotrexate (2)
capsule. 100 mg
injection. 50 mg/ml
in 5-ml ampoule
tablet. 50 mg
(as hydrochloride)
tablet. 2.5 mg (as sodium salt)
procarbazine
capsule. 50 mg (as hydrochloride)
vinblastine (2)
powder for injection.
10 mg (sulfate) in vial
tamoxifen
tablet, equivalent to 60 mg iron
oral solution, equivalent to
25 mg iron (as sulfate)/ml
ferrous salt + folic acid
(nutritional supplement for use
during pregnancy)
tablet, equivalent
to 60 mg iron +
400 jig folic acid
folic acid (2)
tablet, 1 mg, 5 mg
injection, 1 mg (as sodium salt)
in 1-ml ampoule
hydroxocobalamin (2)
injection. 1 mg
in 1-ml ampoule
Complementary drug
“iron dextran (B) (5)
injection, equivalent to 50 mg
iron/ ml in 2-ml ampoule
10.2 DRUGS AFFECTING COAGULATION
desmopressin (8)
injection. 4 pg (acetate)/ml
in 1-ml ampoule
nasal spray. 10 pg (acetate)/
metered dose
powder for injection.
1 mg, 5 mg (sulfate) in vial
heparin sodium
injection, 1000 lU/ml.
5000 lU/ml. 20 000 lU/ml
in 1 -ml ampoule
powder for injection. 20 mg,
25 mg (as sodium phosphate or
sodium succinate) in vial
phytomenadione
injection. 10 mg/ml
in 5-ml ampoule
tablet, 10 mg, 20 mg (as citrate)
protamine sulfate
injection. 10 mg/ml
in 5-ml ampoule
8.3 HORMONES AND ANTIHORMONES
°prednisolone
10.1 ANTIANAEMIA DRUGS
ferrous salt
tablet, 50 mg
powder for injection, 50 mg
(as sodium salt) in vial
vincristine (2)
Section 10: Drugs affecting the
Blood
powder for injection, 10 mg,
50 mg (hydrochlonde) in vial
injection, 20 mg/ml in 5-ml ampoule
tablet, 100 mg + 10 mg,
250 mg + 25 mg
levodopa +
“carbidopa (5, 6)
tablet, 5 mg
tablet, 10 mg
8.4 DRUGS USED IN PALLIATIVE CARE
“warfarin (2, 6)
The WHO Expert Committee on Essential Drugs recom
mended that all the drugs mentioned in the WHO publi
cation Cancer Pain Relief: with a Guide to Opioid Avail
ability, 2nd edition, be considered essential. The drugs
are included in the relevant sections of the model list
according to their therapeutic use, e.g. analgesics.
tablet. 1 mg, 2 mg and 5 mg
(sodium salt)
“ Example of a therapeutic group. Various drugs can serve as alternatives.
255
Essential Drugs
WHO Drug Information Vol. 13, No. 4,1999
Section 11: Blood Products and
Plasma Substitutes
tablet, 250 mg,
500 mg (hydrochloride)
“procainamide (B)
injection, 100 mg
(hydrochloride)/ml
in 10-ml ampoule
PLASMA SUBSTITUTES
11.1
“dextran 70
injectable solution, 6%
“polygeline
injectable solution, 3.5%
PLASMA FRACTIONS FOR SPECIFIC USE '
11.2
Complementary drugs
“factor VIII concentrate (C) (2, 8)
dried
“factor IX complex (coagulation
factors II. VII, IX, X) concentrate (C) (2. 8)
dned
“quinidine (A) (7)
12.3
tablet, 200 mg (sulfate)
ANTIHYPERTENSIVE DRUGS
“atenolol
tablet, 50 mg, 100 mg
“captopril
scored tablet, 25 mg
“hydralazine
tablet. 25 mg, 50 mg
(hydrochloride)
powder for injection, 20 mg
(hydrochloride) in ampoule
Section 12: Cardiovascular Drugs
12.1
ANTIANGINAL DRUGS
“atenolol
tablet, 50 mg, 100 mg
glyceryl trinitrate
tablet (sublingual), 500 pg
cisosorbide dinitrate
tablet (sublingual), 5 mg
"verapamil (10)
tablet. 40 mg. 80 mg
(hydrochloride)
12.2 ANTIARRHYTHMIC DRUGS
“atenolol
tablet. 50 mg. 100 mg
digoxin (4, 11)
tablet. 62.5 pg. 250 pg
oral solution. 50 pg/ml
injection, 250 pg/ml
in 2-ml ampoule
lidocaine
verapamil (8, 10)
“hydrochlorothiazide
tablet. 250 mg
“nifedipine (10)
sustained-release formulations
tablet. 10 mg
injection, 2.5 mg
(hydrochloride)/ml
in 2-ml ampoule
tablet, 100 pg, 250 pg
“reserpine
injection, 1 mg in 1-ml ampoule
Complementary drugs
prazosin
tablet. 500 pg. 1 mg (mesilate)
“sodium nitroprusside
(C) (2. 8)
scored tablet. 25 mg
digoxin (4, 11)
tablet. 62.5 pg. 250 pg
oral solution. 50 pg/ml
injection, 250 pg/ml in 2-ml ampoule
dopamine
“hydrochlorothiazide
injection, 1 mg
(as hydrochloride)/ml
isoprenaline (C)
injection. 20 pg
(hydrochloride)/ml
injection, 40 mg
(hydrochloride)rml in 5-ml vial
tablet. 25 mg. 50 mg
12.5 ANTITHROMBOTIC DRUGS
acetylsalicylic acid
Complementary drugs
epinephrine (C)
powder for infusion,
50 mg in ampoule
12.4 DRUGS USED IN HEART FAILURE
“captopril
injection, 20 mg
(hydrochlonde)/ml
in 5-ml ampoule
tablet. 40 mg,
80 mg (hydrochloride)
scored tablet. 25 mg
methyldopa (7)
tablet. 100 mg
Complementary drug
streptokinase (C)
powder for injection,
100 000 III, 750 000 III in vial
“ Example of a therapeutic group. Various drugs can serve as alternatives.
' All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood, Blood
Components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840,1994, Annex 2.
256
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
12.6
LIPID-LOWERING AGENTS
13.4
The WHO Expert Committee on Essential Drugs recog
nizes the value of lipid-lowering drugs in treating patients
with hyperiipidaemia. Beta-hydroxy-beta-methylglutarylcoenzyme A (HMG CoA) reductase inhibitors, often re
ferred to as 'statins', are potent and effective lipidlowering drugs with a good tolerability profile. Several of
these drugs have been shown to reduce the incidence of
fatal and non-fatal myocardial infarction, stroke and mor
tality (all causes), as well as the need for coronary by
pass surgery. All remain very costly but may be costeffective for secondary prevention of cardiovascular dis
ease as well as for primary prevention in some very highrisk patients. Since no single drug has been shown to be
significantly more effective or less expensive than others
in the group, none is included in the model list: the choice
of drug for use in patients at highest nsk should be
decided at national level.
Section 13:
Dermatological Drugs (topical)
13.1
solution, 15%
ointment, 0.1-2%
ointment, 5%
fluorouracil
solution. 10-25%
"podophyllum resin (7)
salicylic acid
solution 5%
ointment or cream, 10%
urea
13.6
SCABICIDES AND PEDICULICIDES
"benzyl benzoate
lotion, 25%
permethrin
cream, 5%
ULTRAVIOLET-BLOCKING AGENTS
topical sun protection agent with
activity against UVA and UVB (C) cream, lotion or gel
Section 14: Diagnostic Agents
14.1
detergent-based
suspension. 2%
ANTI-INFECTIVE DRUGS
"methylrosanilmium chloride
(gentian violet)
aqueous solution, 0.5%
tincture. 0.5%
neomycin + "bacitracin (7)
ointment. 5 mg
neomycin sulfate
+ 500 IU bacitracin zinc/g
potassium permanganate
aqueous solution. 1:10 000
OPHTHALMIC DRUGS
fluorescein
eye drops. 1% (sodium salt)
"tropicamide
eye drops, 0.5%
14.2
RADIOCONTRAST MEDIA
injection, 140-420 mg iodine
(as sodium or meglumine
salt)/ml in 20-ml ampoule
"amidotnzoate
aqueous suspension
barium sulfate
"iohexol
cream. 1%, in 500-g container
injection. 140-350 mg iodine/ml
in 5-ml, 10-ml and 20-ml ampoule
"iopanoic acid
ANTI-INFLAMMATORY AND
ANTIPRURITIC DRUGS
"betamethasone (3)
solution, 5%
dithranol
ointment or cream. 2% (nitrate)
selenium sulfide (C)
13.3
lotion or cream, 5%
Complementary drugs
Complementary drug
silver sulfadiazine
benzoyl peroxide
coal tar
lotion, 1%
ointment or
cream, 6% + 3%
sodium thiosulfate
13.2
solution, 13% for dilution
13.5 DRUGS AFFECTING SKIN
DIFFERENTIATION AND PROLIFERATION
13.7
ANTIFUNGAL DRUGS
benzoic acid + salicylic acid
"miconazole
ASTRINGENT DRUGS
aluminium diacetate
ointment or cream.
0.1% (as valerate)
"calamine lotion
lotion
"hydrocortisone
ointment or cream, 1% (acetate)
"propyliodone
(For administration only into
the bronchial tree).
tablet. 500 mg
oily suspension.
500-600 mg/ml
in 20-ml ampoule
Complementary drug
“meglumine iotroxate (C)
solution, 5 - 8 g iodine
in 100-250 ml
" Example of a therapeutic group. Various drugs can serve as alternatives.
257
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
Section 15:
Disinfectants and Antiseptics
15.1
17.2
ANTIEMETIC DRUGS
injection, 5 mg (hydrochloride)/ml
in 2-ml ampoule
ANTISEPTICS
“chlorhexidine
solution, 5%
(digluconate) for dilution
tablet, 10 mg,
25 mg (hydrochloride)
“promethazine
elixir or syrup. 5 mg .
(hydrochloride)/5 ml
solution, 70% (denatured)
“ethanol
“polyvidone iodine
15.2
tablet, 10 mg (hydrochloride)
metoclopramide
solution, 10%
injection. 25 mg (hydrochtoride)/ml
in 2-ml ampoule
DISINFECTANTS
“chlorine base compound
powder (0.1% available
chlonne) for solution
solution. 4.8%
“chloroxylenol
solution, 2%
glutaral
“furosemide
ANTIHAEMORRHOIDAL DRUGS
ointment
or suppository
17.4
ANTI-INFLAMMATORY DRUGS
suppository, 25 mg
(acetate)
hydrocortisone
Section 16: Diuretics
“amiloride (4. 7. 8)
17.3
“local anaesthetic, astringent
and anti-inflammatory drug
“ retention enema
tablet. 5 mg (hydrochlonde)
tablet, 40 mg
tablet. 500 mg
“sulfasalazine (2)
suppository, 500 mg
injection. 10 mg/ml in
2-ml ampoule
“hydrochlorothiazide
spironolactone (8)
tablet. 25 mg. 50 mg
tablet, 25 mg
retention enema
17.5
ANTISPASMODIC DRUGS
“atropine
tablet. 0.6 mg (sulfate)
injection. 1 mg (sulfate)
in 1-ml ampoule
Complementary drug
“mannitol (C)
injectable solution, 10%. 20%
17.6
Section 17: Gastrointestinal Drugs
17.1
ANTACIDS AND OTHER ANTIULCER
DRUGS
aluminium hydroxide
tablet. 500 mg
oral suspension. 320 mg/5 ml
“cimetidine
tablet, 200 mg
injection. 200 mg in 2-ml ampoule
magnesium hydroxide
oral suspension,
equivalent to 550 mg
magnesium oxide/10 ml
LAXATIVES
tablet, 7.5 mg (sennosides)
(or traditional dosage forms)
“senna
17.7
DRUGS USED IN DIARRHOEA
17.7.1
ORAL REHYDRATION
oral rehydration salts (for glucoseelectrolyte solution)
Components
sodium chloride
trisodium citrate dihydrate2
potassium chloride
glucose
powder, 27.9 g/l
gTI
3.5
2.9
1.5
20.0
° Example of a therapeutic group. Various drugs can serve as alternatives.
2Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5 g/l. However, as the
stability of this latter formulation is very poor under tropical conditions, it is only recommended when manufactured for
immediate use.
258
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
17.7.2
ANTIDIARRHOEAL (SYMPTOMATIC)
DRUGS
"codeine (1a)
tablet, 30 mg (phosphate)
Section 18: Hormones, other Endo
crine Drugs and Contraceptives
18.1
ADRENAL HORMONES AND
SYNTHETIC SUBSTITUTES
BARRIER METHODS
diaphragms with spermicide
(nonoxinol)
18.4
ESTROGENS
injection, 4 mg dexamethasone
phosphate (as disodium salt)
in 1-ml ampoule
hydrocortisone
powder for injection. 100 mg
(as sodium succinate) in vial
“prednisolone
tablet, 1 mg, 5 mg
18.5
INSULINS AND OTHER ANTIDIABETIC
AGENTS
18.2
intermediate-acting Insulin
injection.
40 lU/ml in 10-ml vial.
100IU/ml in 10-ml vial
(as compound insulin zinc suspension
or isophane insulin)
metformin
Complementary drug
testosterone (C) (2)
18.3
18.6
injection. 200 mg
(enantate) in 1-ml ampoule
CONTRACEPTIVES
’ethinylestradiol +
“levonorgestrel
tablet. 30 pg + 150 pg,
“ethinylestradiol +
“levonorgestrel
tablet. 50 pg
+ 250 pg (pack of four)
“ethinylestradioi +
“norethisterone
tablet. 35 pg + 1.0 mg
levonorgestrel
tablet. 0.75 mg (pack of two)
“levonorgestrel (B)
norethisterone
enantate (B) (7, 8)
18.3.2
tablet. 50 mg (citrate)
PROGESTOGENS
tablet. 5 mg
norethisterone
Complementary drug
medroxyprogesterone acetate (B)
Complementary drugs
medroxyprogesterone
acetate (B) (7. 8)
tablet, 500 m (hydrochloride)
OVULATION INDUCERS
“clomifene (2. 8)
18.7
18.3.1 HORMONAL CONTRACEPTIVES
injection,
40 lU/ml in 10-ml vial.
100 lU/mt in 10-ml vial
insulin injection (soluble)
tablet, 100 pg (acetate)
ANDROGENS
tablet. 2.5 mg, 5 mg
“glibenclamide
Complementary drug
fludrocortisone (C)
tablet, 10 pg, 50 pg
“ethinylestradiol
tablet, 500 pg, 4 mg
"dexamethasone
18.3.3
condoms with or without spermicide
(nonoxinol)
18.8
tablet. 5 mg
THYROID HORMONES AND
ANTITHYROID DRUGS
levothyroxine
tablet. 50 pg. 100 pg
(sodium salt)
potassium iodide
tablet, 60 mg
“propylthiouracil
tablet. 50 mg
tablet. 30 pg
depot injection.
150 mg in 1-ml vial
oily solution, 200 mg/ml in
1-ml ampoule
Section 19: Immunologicals
19.1
DIAGNOSTIC AGENTS
tuberculin,3
purified protein derivative (PPD)
injection
INTRAUTERINE DEVICES
copper-containing device
“ Example of a therapeutic group. Various drugs can serve as alternatives.
3 All tuberculins should comply with the Requirements for Tuberculins (Revised 1985). WHO Technical Report Series, No.
745, 1987, Annex 1.
259
Essential Drugs
WHO Drug Information Vol 13, No. 4, 1999
19.2 SERA AND IMMUNOGLOBULINS4
anti-D immunoglobulin
(human)
°antitetanus immunoglobulin
(human)
antivenom serum
diphtheria antitoxin
injection, 250 pg in
single-dose vial
injection. 500 IU
in vial
Section 20:
Muscle Relaxants (peripherally act
ing) and Cholinesterase Inhibitors
injection. 5 mg/ml
in 2-ml ampoule
“alcuronium chloride (2)
injection
injection, 10 000 IU.
20 000 IU in vial
immunoglobulin,
human normal (2)
injection (intramuscular)
immunoglobulin.
human normal (2, 8)
injection (intravenous)
“rabies immunoglobulin
injection, 150 lU/ml
tablet,' 15 mg (bromide)
“neostigmine
injection. 500 pg, 2.5 mg
(metilsulfate) in 1-ml ampoule
tablet. 60 mg
pyridostigmine bromide (2, 8)
injection. 1 mg
in 1-ml ampoule
suxamethonium
chloride (2)
injection. 50 mg/ml
in 2-ml ampoule
19.3 VACCINESs
powder for injection
19.3.1 FOR UNIVERSAL IMMUNIZATION
Complementary drug
BCG
vecuronium bromide (C)
powder for injection,
10 mg in vial
diphtheria
pertussis
tetanus
Section 21:
Ophthalmological Preparations
hepatitis B
measles
21.1 ANTI-INFECTIVE AGENTS
“gentamicin
solution (eye drops). 0.3%
(as sulfate)
“idoxuridine
solution (eye drops), 0.1%
influenza
silver nitrate
solution (eye drops). 1%
meningitis
“tetracycline
eye ointment, 1 % (hydrochloride)
mumps
21.2 ANTI-INFLAMMATORY AGENTS
rabies
“prednisolone
poliomyelitis
19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS
eye ointment. 0.2%
rubella
solution (eye drops), 0.5%
(sodium phosphate)
typhoid
21.3 LOCAL ANAESTHETICS
yellow fever
“tetracaine
solution (eye drops). 0.5%
(hydrochloride)
21.4 MIOTICS AND ANTIGLAUCOMA DRUGS
acetazolamide
tablet, 250 mg
° Example of a therapeutic group. Various drugs can serve as alternatives.
'All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood,
Blood components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840,1994, Annex 2.
5 All vaccines should comply with current WHO recommendations for biological substances.
260
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
solution (eye drops), 2%, 4%
(hydrochloride or nitrate)
“pilocarpine
solution (eye drops), 0.25%, 0.5%
(as maleate)
“timolol
24.2
DRUGS USED IN MOOD DISORDERS
24.2.1
DRUGS USED IN DEPRESSIVE
DISORDERS
tablet, 25 mg (hydrochloride)
“amitriptyline
21.5 MYDRIATICS
solution (eye drops),
0.1%, 0.5%, 1% (sulfate)
atropine
Complementary drug
Section 22:
Oxytocics and Antioxytocics
OXYTOCICS
“ergometrine (1c)
tablet. 200 pg (hydrogen maleate)
injection. 200 pg (hydrogen maleate)
in 1-ml ampoule
ANTIOXYTOCICS
tablet, 4 mg (as sulfate)
“salbutamol (2)
injection, 50 pg (as sulfate)/ml
in 5-ml ampoule
valproic acid (7, 11)
24.3
DRUGS USED IN GENERALIZED
ANXIETY AND SLEEP DISORDERS
scored tablet, 2 mg, 5 mg
“diazepam (1b)
24.4
intraperitoneal dialysis solution
(of appropriate composition)
DRUGS USED IN OBSESSIVE
COMPULSIVE DISORDERS AND
PANIC ATTACKS
clomipramine
capsules, 10 mg, 25 mg
(hydrochloride)
Section 25: Drugs Acting on
the Respiratory Tract
25.1
ANTIASTHMATIC DRUGS
injection. 25 mg/ml
in 10-ml ampoule
inhalation (aerosol), 50 pg, 250 pg,
(dipropionate) per dose
“beclometasone
parenteral solution
Section 24:
Psychotherapeutic Drugs
“epinephrine
injection, 1 mg (as hydrochloride
or hydrogen tartrate) in 1-ml ampoule
ipratropium bromide
“fluphenazme (5)
“haloperidol
inhalation (aerosol). 20 pg/dose
tablet. 2 mg. 4 mg (as sulfate)
“salbutamol
inhalation (aerosol), 100 pg
(as sulfate) per dose
DRUGS USED IN PSYCHOTIC DISORDERS
“chlorpromazine
capsule or tablet. 300 mg
enteric coated tablet,
200 mg, 500 mg (sodium salt)
“ammophylline (2)
Section 23: Peritoneal
Dialysis Solution
24.1
carbamazepine (10,11) scored tablet, 100 mg, 200 mg
injection, 10 IU in 1-ml ampoule
oxytocin
22.2
DRUGS USED IN BIPOLAR DISORDERS
lithium carbonate (2, 4)
solution (eye drops). 2%
(as hydrochlonde)
epinephrine (A)
22.1
24.2.2
tablet. 100 mg (hydrochloride)
syrup, 2 mg (as sulfate)/5 ml
syrup, 25 mg
(hydrochloride)/5 ml
injection, 50 pg (as sulfate)/ml
in 5-ml ampoule
injection, 25 mg
(hydrochloride)/ml in 2-ml ampoule
respirator solution for use in nebulizers.
5 mg (as sulfate)/ml
injection, 25 mg
(decanoate or enantate)
in 1-ml ampoule
theophylline (10, 11)
tablet, 2 mg, 5 mg
“cromoglicic acid (B)
tablet, 100 mg, 200 mg. 300 mg
Complementary drug
injection. 5 mg in
1-ml ampoule
inhalation (aerosol).
20 mg (sodium salt) per dose
“ Example of a therapeutic group. Various drugs can serve as alternatives.
261
*
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
26.3
25.2 ANTITUSSIVES
oral solution,
3.5 mg (bromide)/5 ml
"dextromethorphan
Section 26:
Solutions correcting Water, Electrolyte and Acid- base Disturbances
MISCELLANEOUS
water for injection
2-ml, 5-ml, 10-ml ampoules
Section 27: Vitamins and Minerals
ascorbic acid
tablet, 50 mg
“ergocalciferol
capsule or tablet, 1.25 mg
(50 000 IU)
26.? ORAL
oral rehydration salts (for glucoseelectrolyte solution)
for composition
see section 17.7.1
potassium chloride
powder for solution
oral solution,
250pg/ml (WOOD lU/ml)
iodine (8)
solution, 0.57 ml, (308 mg iodine)
in dispenser bottle
26.2 PARENTERAL
glucose
glucose with
sodium chloride
potassium chloride (2)
injectable solution,
5% isotonic. 10% isotonic,
50% hypertonic
injectable solution. 4%
glucose, 0.18% sodium chloride
(equivalent to Na- 30 mmol/l
Cl’ 30 mmol/l)
capsule. 200 mg
“nicotinamide
pyridoxine
“retinol
tablet, 50 mg
tablet, 25 mg (hydrochloride)
sugar-coated tablet. 10 000 IU
(as palmitate) (5.5 mg)
capsule. 200 000 IU (as
palmitate) (110 mg)
11.2% solution in
20-ml ampoule, (equivalent to
K’ 1.5 mmol/ml, Cl' 1.5 mmol/ml)
sodium chloride
injectable solution, 0.9%
isotonic (equivalent to Na- 154
mmol/1. Cl’ 154 mmol/l)
sodium hydrogen
carbonate
injectable solution, 1.4%
isotonic (equivalent to Na’ 167
mmol/l, HCO3’ 167 mmol/l)
8.4% solution in 10-ml ampoule
(equivalent to Na’ 1000 mmol/l,
HCO3’ 1000 mmol/l)
° compound solution of
sodium lactate
iodized oil, 1 ml (480 mg iodine).
0.5 ml (240 mg iodine) in
ampoule (oral or injectable)
injectable solution
oral oily solution,
100 000 lU/ml in multidose
dispenser (as palmitate)
water-miscible injection,
100 000 IU (as palmitate)
(55 mg) in 2-ml ampoule
riboflavin
tablet. 5 mg
“sodium fluoride
in any appropriate formulation
thiamine
tablet. 50 mg (hydrochloride)
Complementary drug
calcium gluconate (C) (2,8)
injection. 100 mg/ml
in 10-ml ampoule
“ Example of a therapeutic group. Various drugs can serve as alternatives.
The following changes in the WHO Model List were approved by the WHO Expert Committee on
the Use of Essential Drugs which met in December 1999. The report of the meeting will be
published in the WHO Technical Report Series.
Deletions:, albumin (human); antiscorpion sera.
Additions: acetylcysteine; rifampicin + isoniazid + pyrazinamide + ethambutol; nevirapine; artesunate;
chlorambucil; daunorubicin; ethanol; iohexol.
Replacements: fluconazole to replace ketoconazole; prazosin to replace doxazosin.
262
(PREPARED BY COMMUNITY HEALTH CELL)
~SL
No.
Name of Drug
1.
2.
3.
4.
5.
ANAESTHETICS
Ether
Halothene
Thiopental
Nitrous Oxide
Oxygen
1.
2.
3.
4.
ANTI - ALLERGICS
Chlorpheniramine maleate
Promethazine
Adrenaline
Dexamethasone
1.
2.
3.
ANTIBODIES
Atropine sulphate
Magnesium Sulphate
Pralidoxime
1.
2.
3.
ANTI - LEPROSY
Dapsone
Rifampicin
Clofezimine
SI.
No.
Name of Drug
1.
2.
3.
4.
ANALGESIC/ANTIPYRETICS
Paracetamol
Aspirin
Ibuprofen
Indomethacin
Pentazocine Lactate
Pethidine
ANTI - EPILEPTICS
Phenobarbitone
Diazepam
Phenytoin Sodium
Carbamazepine
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
ANTI - INFECTIVES
Mebendazole
Metronidazole
Benzyl Pencillin
Procaine Pencillin
Benzathine Pencillin
Tetracycline
Doxycycline
Chloramphenicol
Co-trimoxazole
Erythromycin
Amoxycillin
Ampicillin
1.
2.
3.
4.
5.
ANTI - TUBERCULAR
INH
Streptomycin
Thioacetazone
Rifampicin
Ethambutol
1.
2.
3.
4.
5.
6.
1.
ANTI - FILARIAL
Di-ethyl carbamazine
1.
2.
3.
4.
ANTI - MALARIAL
Chloroquin
Primaquin
Sulfadoxin Pyremethamine
Quinine Sulphate
1.
2.
CARDIOVASCULAR
Isosorbide Nitrate
Propranolol
1.
CARDIAC GLYCOSIDE
Digoxin
1.
2.
3.
Antacids
Aluminium Hydroxide
Magnesium Trisilicate
Ranitidine
1.
2.
Anti-emetics
Metoclopramide
Promethazine
1.
2.
3.
Antispasmodic
Atropine sulphate
Dicyclomin
Promethazine
ANTI - FUNGAL
Griseofulvin
Amphotericin B
1.
2.
3.
HAEMOPOIETIC
Ferrous Sulphate + folic Acid
Ferrous Fumarate + folic Acid
Folic Acid
1.
2.
3.
4.
ANTI - HYPERTENSIVE
Hydrochlorothiazide
Reserpine
Hydralazine
Atenlol
1.
2.
3.
DIURETICS
Frusemide
Spiranolactone
Mannitol
1.
2.
3.
LAXATIVES
Isapaghula husk
Paraffin, liquid
Glycerine
GASTRO INTESTINAL
Anti -Diarrhoeals
ORS packets
Loperamide Hydrochloride
(not for children)
1.
2.
HARMONES
Prednisolone
Hydrocortisone sodium succinate
1.
2.
3.
PSYCHO THERAPEUTIC
Imipramine
Chlorpromazine
Diazepam
1.
2.
OBSTETRICS
Methergin
Oxytocin
1.
2.
3.
VITAMINS /MINERALS
Ascorbic Acid
Vitamin A
Vitamin B complex
1.
2.
3.
ANTI DIABETIC
Insulin (plain)
Insulin (Lente)
Glibenclamide
1.
2.
3.
4.
5.
RESPIRATORY
Anti asthmatic
Deriphylline
Aminophylline
Salbutamol
Terbutaline
Oxygen
1.
Anti-tussive
Codeine Phosphate
1.
2.
3.
4.
5.
6.
REHYDRATION ACID BASE
ELECTROLYTE balance
I.V. Dextrose
I.V. Sodium Chloride
I.V. Dextrose + Saline
I.V. Molar Lactate
I.V. Sodium Bicabonate
Potassium Chloride
SKIN & STD
1.
2.
3.
■ 4.
5.
6.
7.
8.
9.
Zinc Oxide Ointment
Whitfield ointment
Benzyl benzate
Neomycin+bacitracin
Gention violet
Miconazole ointment
Pencillin
Doxycyclin
Norfloxacin
1.
2.
3.
4.
EYE DROPS
Tetracycline
Pilocarpine
Humatropine
Chloramphenical '
1.
2.
3.
4.
5.
6.
7.
8.
ACCESSORIES
Water for injection
Hydrogen peroxide
Chlorhexidine
Absorbent Cotton
Gauze, small & large
Bandage
Butterfly (scalp) venesets 18,21,24
Sutures
Black braided silk
Mersilk
Catgut, plain
Catgut Chromic
Prolene, atraumatic
Vicryl
Cotton thread
9.
10.
11.
12.
13.
14.
15
16.
17.
18.
19.
20.
21.
Suture Needles
Hypodermic Needles
Gloves, surgical
Ryles Tubes
Adhesive Plaster
Elastocrepe bandage
Plaster of Paris
Surgical Spirit
Drip set: administration; fluid, blood
Cannula, IV for venesection
Syringes
Catheters, plain
Catheters, Foley’s
Bleaching powder
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11
12.
13.
EMERGENCY DRUGS
Oxygen cylinders on trolleys, with
flow meters and mask
Dopamine
Hydro cortisone
Lignocaine
Atropine
Sodium Bicarbonate
Pralidoxime
Adrenaline
Mephentermine
Mannitol
Magnesium sulphate
Trachestomy set, 24,27,30,36
1.
2.
3.
4.
VACCINES & SERA
All vaccines as per National
Universal Immunization Programme
Anti Rabies serum
Anti Snake Venom Serum
DIAGNOSTIC AGENTS
As needed
This list has been prepared using the following lists for reference:
model list of essential list
Essential drugs in Primary Health Care in India, Southern region list, prepared at
National Seminar conducted by NIPCCD.
3. Lists of drugs received from Government and other sources
4. CHAI-CMAI formulary.
1.
2.
sSSEwriAl DRUGS LIST
MMSIIIUICS
Ether, Anaesthetic
Halothane
Thiopental
Nitrous Oiid»
Oaygen
Prepared by Community Health Cel"!
Tablets
Capsule--
(51
' (41
'
of Karnataka.
Injections ~
Syruo
(51
(61
Inhalation
Inhalation
0.5, aap
Inhalation
(Refer Earrgency Drugs)
ftKAlGESIC/AKUPTREUCS
Paratclaiol
Aspirin
Ibuprofen
Indoae *clh i«
Ptnlaiocinr tactile
Pethidine
MU-ft LEF.GICS
.hlorphrniraains naleale *
•frcn» limine
Adrenaline
Deaaaelliasune
AHU-EPILEPTICS
fhruobirbitone
Diaiepaa
fhcn/l h Sodm a
Carbaeat<pini
*p
300(j./2it.i
WOtj.
300a,
200a,
(00a,
USq/Sal
35.)
. 30ag/tl
SOig/i!
(a,
l«H
25<1/>I
0.S1]
1 In 1000, hl up
4ij/il, 2«l Yial
io!)
lOOaj .
*1
100
Waj
5«7/5«l
200ag/al
30.)
10.)
2a9/5al ’
SOiQ/nl
-I-
100i]/4jI
SOOOOOU/fi l
2. Procalnt Ptncillln
(OOOOOUMil
2000000U/tlal
3. Itnaalhine Ptncillin
•
25.,
1. Itn:rl Pendllin
’
IOOOOOOV/tIiI
I
WOONU/yIiI
I200000UMH
2(OOOOOU/vh|
ill
(2)
(1)
(J>
fl)
(5)
(*)
171
ANII'IUKKUU
1. IKH
2. Slrtptoiycln
3. IhioKttnonr
1. lilaopich
5. Ethaib-jlol
100.)
If/vlal
150.J
(lefer tat
7M.|
iritMtIrtalttal
iff litionil
Mffctloiit Control Preprint I banned coibiaationi in the
of lubtrcoloihl
AHfl-riLMIAL
Pl-flhfl carbatarinr
MI-HMGK
Grittolvlio
fapMtrkia 1
AMI I-WIMIM,
Chlcrojula
friaaqiia
Svl hds> hifjr t tf thaiinr
Oviniot Sulphate
5*1
its.
I20oj/5d
j
SOog/vlil
!W«j bite
12.* 5
s.yoi]ir.25»i
3W»|
lOtj/il
JOOif/itp
wcwroicnc
rrrrovs Sulplult’f olic kid
Ferron fu«uati’folic Acid
Folic At id
CAX0I0VASCU.M
Aati-anflnil
Itosorbidf Nitrate
Propran-ilnl
2^'»|’0.5»|
*1I5O ’2/.«1
51
IO«j
*140ICM
•
1
(21
III
HI
14)
(7i .
III
(21
1)1
<l>
2. I.V. Sodiut Chloride
3. I.V. *SDeialitnrosr
e
4. I.V. fl>hr l.adalt
5. I.V. Sodiaa licvrbonate
i. Pohiiiua Chloride
YIIAflinS/fl MERAlS
. Ascorbic Acid
Vilaain A
. Vilnin 1 coaplet
SKIM I Sil
1. be r i rbj 11 tar
Aainophjl iae
I.
IlOa^/al
bOag/Sal
25a9/al
4.
2<j/5el
O.Sag/al
0-.,T3
• Anli-lmiTt
I. Codeine Ifcavphalr
flPilEIHCa
lakllalina
(i)
51,101 in 5>Jal
251,501 ia 2hl
•JI ia SOCil
|.5l‘S.0JI in Wtl
300a I
7.51 la IOal/25al i*p
1. I.V. Dtdro-.r
Mbl'IUUi
131
(71
IEHVORATIOM AGIO BASE aECMOlYTE balance
. line 0<i4r *i(oi<U«h
Whitfield (olaUtnll
PtM/l Beaioilr (tauhionl
. Utotycia»11ciIrac in
Gentian Violet
KiC'XUMla (oinl»»nll
Peni'illins
Ooiycrclia
Morfloiacio
•*
i^/30.1 la
IWa,
*A-» IU
T»i
M000 IU
Tn
50000 lU/al
Tn
Tti
21 (aialatc
21 (aialiic
251 Itailil
Bovdir, Ola
II lohlioa
21 laialau
(Ider AftU'lacteriilt aborel
(Beier Mi-li'ltriili above)
l»a;
C1E CP-JT-5
0.2ag/al
5 IU/.I
10 lU/al
I. IrlrKyclii
*
2. Pilocarpine
3. Hvaelropine
4. Chlor nphtaicol
II loinlaenl
Il (drop)
Il (drops!
Il lolalatal
0.<l (drapl
II
121
ill
14)
(4)
(5)
200ag/5al
(Refer Hortonti)
11 , 21
(Refer in Anthpataodlct)
(Refer Rehydration)
(Refer *)Antidote
(Refer Ihli-AIIergictl
(Refer frirelac
*!
(Refer Undated .>
Naler lor injection
tljdc'.gen peroivle
Chlorl.ea idine
Absorbent Colton
Saute, (aall 4 large
Bandage
duller fly (scalp) unite!
*,
18, 21, 21
*mature
flack braided till - 1, 1.0, 2, 2.0, I, 3.0
Nertilk • 1.0, 2.0, 4.0
Catgut, plait - 1, 1.0, 2, 2.0, 3, 3.0
Catgut, chre.ic - 1, 1.0, 2, 2.0, 3.0
Prolene, atrauaalic - 1, 1.0, 2.0, 3.0
Vicryl • 5.0, 4.0, 3.0
Colton thread
lure *Needle
poderaic *Needle
O’*,/e surgical, 4, 6*1/2, 1
'les lubes
0.5g powd./vlal
1 in lOOO/al aap
ISag/el aap
2(1 la 350.1
501 in aap
<JI
<<l
<51
r, r, r width
VACCINES 4 SIRA
I. Al! *Vaccine a* per Mat tonal Universal hou..iiatinn frograne
2. Anti *fable Stria
■;
J. Atli $na
*e Venoa Strua
)
OIAW.IIC ACEnlS
•
* M»4td
A
*Aapule
4X Solution
41 W/V liquid
-7 —
ij. a6Smi»«
It. *lEiv<'aere bandage, V, 4* rol 11
15. Flatter al Fart
*
14. Surqical Spirit
IL Drip let : adainhtratloni fluid, blood
if. Cannula, IV for vene
*?ction, 14, If, 2? and paediatric files.
IL *Syringe
20. Catheter
*,
plain, 3, 4, ! •
*,
Catheter
**,Foley I, 12, IS, 20
21. Bleaching po«drr
ehergenct drugs
Oiygen *cylinder on trolley
*,
with
Flew otter
* and natk
Dopaaine
Hydro cortisone
lignocaine .
Atropine
Srdiua Bicarbonate
rralidoaiat
Adrenaline
HephenteraIne
Hannilol
IV'i wKi'it sulphite
*ylri>acl.e tel, 21, 27, 30, 34
ACCESSORIES
12)
ill
(71
*Hi list ha* btm prepared using the following list
* (or reference
I. V.H.fl, aodel lilt of essential 11*1,
2. Eitenlial drop in Friaary Health Care in India, Southern region list,
prepared at National Seninar conducted by NIPCCO.
3. list
* of drug
* received froa Governaenl and other *.inurce
I. CHAI-CMI foraulary.
Sal, |0aI *aip
10wl
(41
ESSENTIAL DRUGS LIST ; Prepared by Community Health Cell for Govt, of Karnataka.
...
SI.t"...Maae...........
of Drug
No.
(21
iWAESII CriCS
I. Ether, Anaesthetic
2. Halothane
J. Thiopental
(. Nitrous Oxide
S. Oxygen
Tablets
(31
Capsule
(41
Injections
' (5)
Syf'jo
(&l
Others
(7)
inhalation
Inhalation
0.5g aap
Inhalation
(Refer Emergency Drugs)
ANALGESIC/ANU PYREIKS
1. Paracetamol
2. Aspirin
5. ibuprofen
4. Indcaethicin
5. Pcnlatocine taclalp
S. Pethidine
AIIH-ALIERGICS
W0»g.
300ag
200og
400ag
1. Chlorphcnirmains oileale ;
". •fn.'selhizine
a ^Adrenaline
lag
•>
300ig.72al.aap
125ag/5al
•
25ag
25.,
25.,'
4. Dex atethasune
ANn-EPILEPHCS
0.5.,
1. Phenobarbitone
2. Diazepaa
J. Phrn^n Sodiun
4. Carb zepine
3O.Wagg
-!lO•#ag
100a? .
IGOxq
30ag/»|
50ig/«i
25ag/al
5ag/5«l
1 In 1000, lai aap
Ing/al, 2al vial
I. Atropine sulphate
2. Nagnesiua Sulphite
3. fnlidotiie
ANfl-IMICHVES
Anti-hehinlhic
I. Mebendazole
Anti-aaoebic
I. Metronidazole
Anti bacterial
1. Benzyl Pencil in
100ag/5al
2. Procaine Pencil in
3. Senulhine Pencil in
I. Tetracycline
5. Doxycycline
6. Chloraaphenicol
7. Co-triaoxazole
8. Erylhroayrin
9. Aaoxycil in
10. Ampicil in
250ag
JSO.g
!M'’
1,/viil
250ag
lOOag/vial
250ag ' 250ag/vial
I. Dipsone
2ag/5al
i00ag/431
500000U/via!
l000000U/Yial
400000U/vlal
2000000U/vial
600000U/vial
1200000U/vyiiaall
24OOOOOU/
lOOag
ami i -ifrsKr
200ag/al
. S-S/«l
50ag/al
(71
ANTIDOTES
Rifaapicin
Clofazimine
-2
ISO.g/5.1
no.,.5.200.,,5.1
125.,/S.l
125ag/5al
I25ag/5i|
(41
(II
(?)
ANT I-TUBERCULAR
(31
1. IKI
2. Streploaycin
3. Thioacetazone
t. Rihtpicin
5. Ethaabulol
IMaj
(4)
(51
(&>
Ig/viai
150ag
(Refer Anti-•Leprosy)
200ag
(Ovag
(Pleasetreataent
see NatofionalTubercul
Tubercul
o
si
s
Control
Prograaae
I banned coabinations in the
osis!
ANTI-FILARIAL
1. Di-ethyl carbaaatine
5- >q
AXfl-FUNGAL
1. Griseofulin
2. fapliutericin I
ANII-HAlARIAL
125.g
1. Chloroquin
2. Priaaquln
3. Sul fadoxin>Pyrea?lhaaine
(. Quinine Sulphate
HAEMOPOIETIC
!. ferrous Sulphale»Folic Acid
!. Ferrous fuaaraU>falic Acid
. Folic Acid
CARDIOVASCULAR
Anti-anginal
. Isosorbide Nitrate
. Propranolol
IQvag base
2.Seg
S.W0agip.25ag
JOOtg
(71
I. H/droc hlorothi ar ide
Cifdiic glycoside
I.
0.25ag/al
Digoxin
0IUFEHC3
lO.g/al
120>g/5al
2UI *iniu>ic.
3. Mannitol
IRO INIKIIHAl.
CAj
!. Ahniri i'a Hrdroeide
2. Pignesp.a Irisilicate
?. Ranitidine
Anti *eaetics
I. Metocloc,ra»ide
50ag/vial
40ag/«l
5ag/5al
(Fefer Mi Allergies)
300ag/aip
•
*g20C'»0.5fcg
ISQag^.'iag
Sag
fi'ifi spa-iodic
I. Atropine sulphate (Refer Anildoles)
2. Oic/cloain
3. *iFinei>sell>a. (Refer Anti-A|lergic$)
MH OlAfftNtfl/i
I. 0?.» Paehls •«•!) f'jrcjhl
2. l'.«per»»i
uride
(notdeforl rdrcchl
children;
LAfAflVES
IQag
It.,
40ag
3-
O.hag/il
(31
(2)
REHYDRATION ACID BASE ELECTROLYTE balance
1. I.V. Dextrose
(()
(II
> ,*..||
■'•■■■iQi'Sl
A!JH PUH I C
1. insulin (Fliin)
Insulin (lente)
2. 51 il-enc 1a* ide
?irC3 ’ “-JHIC
I. Inpraime
2. Chlorproiaune
j
Si*g
1. Ascorbic Acid
2. Villain A
3. Vitaiin B coiplex
SKIN I SID
CCA h
7"j«
IQag
5. Guzepat (Refer wili-Epileptics)
MVIRAhM
1. Deri phylline
2. AatrophyI I me
gI*Ov
|i)C«g
J. Saitrjlaid
?<j
<. Terbutaline
1. Zinc Oxide *N(oi>Unt
2. Whitfield (oinlaenU
3. Benzyl Benzoate (e*ulsion)
(. Ileoiycin’Bacitracin
5. Gentian Violet
h. fiicon-wole (oinl»»nl)
7. PeninIIins
8. Ooiycydin
?. Norfloxacin
<«9
2.5,5
5. Ocjg-a
■ Anti-tussive
® Codeine phosphate
OBiiEiaics
jn«j
I:. Hellirrgih
2. Oxytocin
O.?5a$
Ul
51.101 in MOil
251,501 m 2511
0.91 in 500il
0.51’5.0.91 in 50011
550 it
7.51 in *11011/25 a*p
2. I.V. Sodiui Chloride
3. I.V. Dextro$e»Salme
1. I.V. Kolar Lactate
. I.V. Sodiua Bicurboiule
6. Fotassiiji Chloride
VlUnil S/niNERALS
2. Hydrocortisone *st-di^ succinite
5. £<'••;»»>« ;.•••$ Ip
*;
IS)
100*9
iu
Yes
50000 IU
Yes
50000 lU/il
Yes
Yes
21 (□ in tier.
21 lolntiec •
251 (eiulsi
Pcider, Qin
11 solution
21 (ointien
(Refer Ant i-Bac ten a Is above)
(Refer Anti-Bacterials above)
(OOaj
CTE CMPS
*l0.2»g/
510 lU/il
lU/il
1. Telracyc li'i»
2. Pilocarpine
>. Huiatropine
1. Chlorasphenicol
IX (ointient
IX (drops)
IX (drops!
IX lointienl
0.1X (drops)
(II
<2>
EMERGENCY DRUGS
1. Oxygen cylinders on trolleys, with
flew aeters and task
2. Dopamine
3. Hydro cortisone
4. lignocaine
5. Atropine
6. Sodiua Bicarbonate
7. Tralidoriae
8. Adrenaline
9. Kephenleriine
10. Kannilol
II. *st1gin'i» sulphate
12. Irachestoay set, 24, 27, 30, 36
. ACCESSORIES
II)
(4)
(5)
(&>
(7>
2C0ag/5al
(Refer Horaones)
n , 21
(Refer in Antlspasaodics)
(Refer Rehydralion)
(Refer Antidotes)
(Refer fat i-Al I erg icsl
(Refer Diuretics!
(Defer Antidotes)
1. Hater for injection
2. '.lydacgen peroxide
3. Chlorhexidin?
1. Absorbent Cotton
5. Saure, saall 1 large
6, Bandage
7. Butterfly (scalp) venesets, 18, 21, 24
8. Sutures
Black braided silk - 1, 1.0, 2, 2.0, 3, 3.0
Hersilk - 1.0, 2.0, 4.0
Catgut, plain - I, 1.0, 2, 2.0, J, 3.0
Catgut, chronic - 1, 1.0, 2, 2.0, 3.0
Prol
Victrylonene,thread
- alrauntic
5.0, 4.0, 3.-0 1, 1.0, 2.O, 3.0
Col
9. Suture Needles
10. Hypoderaic Needles
II. Gloves, surgical, 6, 641/2, 7
12. Ryles lubes
0.5g poxd./vial
I in 1000/al aap
ISag/al aap
2;I in 350al
S')l in aap
(51
VACCINES I SIRA
I. All Vaccines as per National Universal lai.j..i ration Prograaie
2. Anti Rabies Senn
•;
J. Anti Snake Venoa Serui
OIAGI.QMIC A6ENIS
flapules
61 Solution
41 H/V Liquid
-7"
ill
121
(JI
(41
13. Adhesive Plaster, (’, 4’ doth
14. fhducrrpe bandage, 7’, 4' rolls
15. Pinter of Paris
16. Surgical Spirit
17. Drip set : adiinistration: fluid, blood
18. Cannula, IV for venesection, 16, 19, 22 and paedialric sires
II. Syringes
20. Catheters, plain, 5, 6, 9 •
Catheters, Foley's, 8, 12, IS, 20
21. Bleaching ponder
As needed
This list has been prepared using the following lists lor reference
I. M.H.O. aodel list of essential list,
7. Essential drugs in Priaary Health Care in India, Southern region list,
prepared at National Sednar conducted by NIPCCO.
3.4. LiCHAIsts-CHAIof drugs
foraulrecei
ary.ved froa Government and other sources.
5al, 10a! asps
10d
(61
\(7I
l.'SI
: PrePared bY Community Health Cell for Govt, of Karnataka.
Tablets
(3)
Capsule
(41
Injections
(5)
Syrua
(61
iWAESIUHICS
I. Ether, Anaesthetic
2. Hiialhiee
Others
(7)
(2)
AXflOOTES
1. Atropine sulphate
2. Xigneii j. Sulphate
3. Pralidotiie
Axri-WECTIVES
<11
(. Xi Iren Oiide
5. Oiyqen
Anli-htl.inlhic
I. ttebendnole '
Anli-noebic
1. hetronidizole
AXALGK®/ftMriPTR6nr.S
Anti bacterial
• Benzyl Pencil in
3.
Thiopental
Par icflnol
Asp ir in
Ibuprofen
|r.dc«elhKin
Peali ocine liclile
Pethidine
iVin-ALLEGClCS
*l300i
.i p g./2
*,SOO
.
300«q
200ag
(00*9
I25q/5.l
25«9
lag
IC'ig
25*g
Adrenaline
OemrlliHune
Md-EFILEPnCS
O.Sag
fheiiobirbi tone
Oia:e;u
Phenyl •< Sodius
C«r?ati«epir<3
*93060*g
—(Oagj
1001)
(COxq
2'Ms)
til
* g/
l30i
50ig/<|
2Siq/it
Sig/Sil
I In 1000, lil up
Ug/il, 2tl rill
-1-
171
*l (pa
4g/|0
lOOig
100ig/3.1
*g200
lOOig
IOOig/5»l
500000U/rii|
IOOOOOOU/yIiI
25O«9
100.)
2.0ig
r.8Q19»S*9.400
250q
1
400000U/»li|
2000000U/rh|
600000U/»h|
1200000U7
*i
11
24OOOOOU/Ti l
Ig/viil
*9
250
lOO.g/Yiil
*9250 . - 250ig/Ti—il
Aiiiiirrsosr
*g/i|
200
SO.g/al
(6)
0.5g pond, in till
• Procilne Pencil Un
Iilficycllnt
Doxycycline
Ch lor 1ephenicol
Co-triiomole
Erythroiycin
A*oiycillin
A.picillin
(51
0.6ig/il
Bcnuthine Pencil in
25*1
Chlorphcnira.ins oileile
•Prcselh-nint
(3)
2ig/5i| ’
^OOag/lal
-2-
150ig/5il
*sr.<o.,
.7ao. g/3.i
I75iq/5.|
I25i}/5il
I25ig/5il
(5)
(1)
AN1I-WHKU.AR
IW
Slreptoeycia
Ihioacelaioeie
iilatpicis
Ethitbulol
!OOtj
(71
(21
*tensit-hycve
rAnl
H/dr ochlorothi«ide
Kcserpine
Urdratatmr
A** hl
n<i
Ij/titl
150t;
(Refer Anli-leproty)
*?
JOO
<0v*3
irieisfIrcaittnl
irt XilofionilTubercul
lubercol
c
si
s
Control
Progrmt
L bn.nrd cotbin)Lions in the
osis)
MH-nitflAL
Mil -FUXGM.
Gr i srolulin
/tpnottrkia )
AK!|« Ml ARIAL
ChloroQuin
Pfittquin
Sul **hdotiniryre tha
* jne
Quinine Sulphate
HAEWPDiniC
Trrrous SulpLale'Folic Acid
ftrr'w futarale‘Folic Acid
folic Acid
CMD10VASCIA.AP.
Anti-anglnal
hojorbide Nitrate
Propranolnl
*3
125
S4*3/vlal
10v*g have
32.* 5
*gS.5O0»g«r.25
*3
300
40t;/tl
Kr loiloNHide
*«h
ft
JOOig/aip
Atropine snlphale (Refer Antidotes)
DiqcImia
rrvtrlU.’i'iP (kcljr Anti-Allergicsl
ANTI DIATSWttS
* 10.5
3200
*3l5>2.0 S«g
S>3
OPS PadelioS-’l Furauhl
*irl«d#?ne (not forHrdrochl
children)uride
LAfAlIVcS
Isr-aghula host
Paraffin, liqiid
Glycerine
IO«g
*340IC-tg
-3-
Granules
liquid b/ i
Suppositorf
°.L..S-.!SI.
SI.
Xo.(11
Man of Drug
(2)
: preMr<xi by Community Health Cell for Govt, of Karnataka.
Tablets
(51
Capsule
’ HI
Injections
(51
Syrua
(41
*Other
(11
4g/|0il l^>»
»wa-snin ics
Ether, Anaesthetic
Halothane
Thiopental
Xitrcui Oiide
Oiygen
Inhalation'
Inhalation
0.5g up
Inhalation
(Refer E *ergency Drugs)
Anti bacterial
1. 8en.-y| Penci 11 in
AXMESIC/MflPTREnCS
Parxctnol
Aspirin
Ibuprofen
Ir.dc.e *Clh in
Penlaaocine lactate
Pethidine
A.1H-M.LE&GICS
Chlcrphtnimins Daleale
■Frcs'lharine
Anti-he IaiAthic
1. Hebenduole '
Anli-aiotbic
1. hetronidarole
JOOig,/2i1.a*p
*gW0.
*g
300
200aq
*q(GO
!25ig/5il
•
25*9
25*9
*g30/»l
SOig/«l
lag
Kuq
25ag/il
*)
0.5
1 in 1000, hl aip
dig/il, 2«i Yial
Adrenaline
Oeiairl >a>une
ANn-E?IL£PnCS
Fhruobarb i tone
40i30*9 g
*9/11
200
Phea/l n Sodios
*a;<pine
Carha
1001)
2'lOWOiagg
*l50ig/
*l5g/5
lOOig
I00ig/5il
200»g
(OOag
lOOig/511
2. Procaine Pencil in
3. Bentalhint Pencil in
1. lelracycllnt
5. Doxycycline
4. Chloramphenicol
/. Co-triioxaaole
8- Erythroiyrjn
1. Aioiycillin
10. Aipicillin
A.’iiiirrnfisr
250ig
1001)
250ig
Ig/vlal
250ig
25O.g .
100ig/Yial
250ig/Yial
I.SOig»S.4001)
250»g
SOag
lOihj
^OOag/hl
SOOOOOU/rial
lOCOOOOJ/vi al
<00000U/»lal
2000000U/Tial
400000U/rtal
ZlHOOOOOU/
OOOOOU/vrllaall
*g
150
3'* 10 g
30.g
100.g
-2-
ISOig/Sil
T. (OigiSJOOig/Sil
I25ig/3il
I25tg/5il
I25ig/Sil
(7) .
Ill
(I)
(2)
(J)
KEHrORATIOX AGIO BASE ELECIROCTTE bilaace
51,101 in 500*1
251,501 ia 25*1
0.71 ia 500
*1
0.51'5.0.71 ia 500*1
500al
7.51 ia *110/25 up
I. I.V. Oedro'.e
ZS-p/al
*!
lag/
I0U/.1
(OU/al
I.
*iIne
;ra
2.
Chlc.'rroti.'inr
3.
2. I.V. Scdiut Chloride
3. I.V. Dritrosr'SaIme
4. I.V. frihf Ijclde
5. I.V. *Sodju BicurbouHf
6. *Potassla Chloride
VIIA.1IU5/rtlNERALS
SCOOO IU
&u:?r»» (Refer Anti-Epileptics)
. Imt Ocidf (oint«Ml
. Vhili eld (omUeat)
Fe'url PmoHe (e»ultionl
l eoaycio'tKitncin
Genina Violel
*/rini>le:un loinl»»ntl
Feniril ins
Oorycyclin
liorlloiKin
RrwICiluKj
4. Trrbrtihnr
5. O'.jT-a
' Anti *
1. Codeine I bosptalr
OPilEIzlG
50000 IU/.I
(Refer Anti-Sac teria Is above)
(Refer Anti-Bacleriah above)
* j
<00
-Iwssiy
CTE CROW
9/
*!0.2
510 IlJ/al
IU/.1
felracyclin?
Pilocarpine
Hi'«alr opine
Chloraiphenicol
ll ioialaenl
Il (iropd
11 (drops)
ll Iciataeat
0.(1 (drops)
(7)
(1)
EnCRGENCY DRUGS
I. Dayqen cylinders on trolleys, with
t lev meters and mask
2. Dopamine
3. Hydro cortisone
4. lignocaine .
5. Atropine
6. Sodium Bicarbonate
7. fralidcxime
9. Adrenaline
1. Mephe.nlermlne
|0. Nanni tel
II. N’-n*si«i s'l phsle
12, I rad.es I cm y sei, 74, 27, 30, 36
ACCESSORIES
200mg/5ml
(Refer Hormones}
Il , 21
(Refer in Antispasmodics!
(Refer Rphydration)
(Refer Antidotes)
(Refer Anli-AIlergics)
(Refer Oi-irelicsl
defer Antidotes) .>
I. All Vaccines as per National Universal l*u«..iration Programme
2. Anti Rabies Senn
3. Anti Snake Veno» Serum
OlAGKOHir
61 Solution
41 M/7 liquid
I. Bandage
7.
7
151
VACCINES I SIRA
agehIS
I. Miter lor injection
2. l /di.'i-jrn per-able
3. Chlorl>fiidin»
I. Absorbent Colton
5. Saure, small I large
Butterfly Iscalp) Yenesets, IB, 21, 24
8. Sutures
Black braided silk - I, 1.0, 2, 2.0, 3, 3.0
Rersilk - 1.0, 2.0, 4.0
Catgut, plain - I, 1.0, 2, 2.0, 3, 3.0
Catgut, chromic - I, 1.0, 2, 2.0, 3.0
Fro
atraumati
Victlryloenaf,t-hread
5.0,
4.0,c3.-0 1, 1.0, 2.0, 3.0
Cot
9. Suture Needles
10. Hypodermic Needles
It. Gloves, suigiral, 6, 641/2, 7
12. R>l»s lubes
0.5g poxd./vial
I in 1000/ml amp
tSig/al amp
201 in 350ml
SOI in amp
(31
(4)
ill
(2)
13. Adhesive Plaster, r, 4* vfdlh
14. Eli'lucrepe bandage, 2’, 4" rolls
15. Plaster ol Paris
16. Surgical Spirit
17. Crip set : administration: fluid, blood
IB. Cannula, IV lor venesection, 16, 17, 22 and paediatric sires
17. Syringes
20. Catheters, plain, 3, 6, ? '
Catheters, Foley's, 8, 12, 16, 20
21. Bleaching po»der
As needed
This list has been prepned using the folloxing lists for reference
I. M.H.O. model list of essential list.
2. Essential drugs in Primary Health Care in India, Southern region list,
prepared al National Seminar conducted by XIPCCO.
J.4. lists
of drugs
CHAI-CMI
formulrecei
ary.ved from Government and other sources.
5m|, 10*1 asps
10*1
(61
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QUOTES
"As commodities, prescription drugs behave
differently from most other items
*
they are
products that the ultimate consumer rarely
selects for himself, The producer *
s
sales
effort are directed at the "instrumental
consumer", the doctor who prescribes but
does not pay for the product....Physicians
receive their most intensive in-service from
agents o,' the chemical industry."
- Ivan Illich in
•Limits to Medicine
"In 1973, the entire drug industry spent
aii average of #4500 on each practising
physician (in U..5.A.) for advertising and
promotion".
~ Ivan Illich in
liimits
*
to Medicine
uiUc
CS j ' u S ’
2-
A handout prepared as guidelines for exploration
of the theme with the participants of the Health
Management Course at St John’s Medical College,
Bangalore
A Rational Drug Policy (issues and prospects)
1,
"Eternal vigilance is required to ensure that
the health care system does not get medicalised,
that the doctor-drug producer axis does not exploit
the people and that the abundance of drugs does not
become a vested interest in ill-health".
—ICMR/ICSSR Health for All Report,
2.
i.
1981
Understanding Irrationalities of the present situation
45000 formulations available in India while WHO
says 200 are essential and Hat'nic Committee in India
says 116 are essential.
ii.
Twenty percent of drugs are substandard and spurious
iii.
The formulations available includes
—irrational combinations
—hazardous drugs
—banned drugs and bannable drugs
—costly drugs
iv.
Inadequate drug legislate011 and drug control
v.
Shortages and non-ffValiability of essential drugs
vi.
Non availability
vii.
Unethical medical advertising and drug company
and life saving drugS
unbiassed drug information
sponsored mlsinforrnation
2
2
viii.
Irrational prescribing practices of medical
profession induced by doctor-drug producer axis
ix.
Tonics, vitamins and enzymes are in excess whereas
anti-TB and anti-leprosy drugs and Vit. A are in
short supply.
x.
Drug policy is an industrial policy not a health policy.
xi.
Increasing prices or inadequate price control
xii.
Drugs as a substitute for caring—new medical culture.
3.
Some_issues
a.
Brand vs. Generic names
b.
Drug/business - dumping
transfer pricing
profit orientation
mis-information
corrupting control systems
doctor-drug producer axis
(one of the biggest and most profitable business
in the world today).
c.
Inadequacies in Medical/Nursing education and
d«
Consumer Awareness/consdmer protection forums
e.
Absence of health personnel's continuing education
f.
Floor moppers to Tap turners off
health team training
- the increasing role of preventive/promotive health care
4.
i.
Components of_a_Rational_Dru2_Policy
Drug availability/production in eonsonance with health
with health needs of the people.
3
3
iio
Elimination of irrational, useless and hazardous drugs
iii.
Low cost drugs in adequate quantities particularly
iv.
Adequate quality control and drug control
v.
Availability of unbiased drug information and ethical
essential/priority drugs
marketing of drugs
vi.
Drug legislation reform
vii.
Generic prescribing
viii.
Technological self reliance
ix.
Increase drug availability through fair price shops
and government health infrastructure
x.
Training of health personnel in Rational therapeutics
and rational drug policy.
i.
Educate yourselve.
on rational drug pblicy
and rational therapeutic issues.
ii.
Share and disseminate information to all staff and
colleagues in hospital and associated centres.
iii.
Adopt essential drug list using cost, efficacy,
safety
and quality as criteria. Evolve a hospital formulary
and purchase and stock drugs in accordance with this.
iv.
Adopt 'generic' concept during purchasing, prescribing
and dispensing drugs.
v.
Weed out the following types of drugs from the hospital
pharmacy;
a.
banned and bannable drugs
4
b.
Irrational combinations
co imitative or me-too drugs
d.
costly drugs with cosmetic embellishments
and elegant packaging
e.
vi.
vii.
Drugs with inadequate evidence of greater value
Avoid injection and tonic practice
Avoid drug industry linkages—gifts, sponsorship,
unethical trade discounts and other forms of inducement
bulk purchasing and or supports cooperative
Adopt
viii.
purchasing and production ventures.
ix.
Evolve a system of health education on drugs (use,
misuse and overuse) for patients and also a continuing
education for hospital personnel.
x.
Join and participate in groups at local/regional/
state/national level who are interested in rational
therapeutics/rational drug policy/consumer awareness
issues.
xii.
seek information on other forms of treatment.
Adopt open policy to rationally tested non-allopathic
systems and non-drug therapies and incorporate in
work.
xii.
Promote 'Health for All
*
priorities:
a. simple home remedies;
b. health education
c.
community health initiatives;
d.
development programme; e. community organization and
awareness building.
^....5
5
SugcjestionS-for^Reading
1. A Rational Drug Policy (All India Drug Action
Network and Voluntary Health Association of
India publication Rs.20.00).
2.
Banned and Bannable drugs, Health Action Series 2,
VHAI publication, Rs.10
3.
4.
Towards a People Oriented Drug Policy
(Medical Service, Vol 41 No.9 Oct-Nov 1984
and Vol 42, No.l January 1985, CHAI)
Drugs-Fact, Fallacy and Fraud
The Journal of Christian Medical Association of India,
Vol LX, September 1983, No.9
5.
Getting Essential Drugs to People
CONTACT, No.63 August 1981.
6.
Strengthening & Regulating the Supply, Distribution
and Production of Basic Pharmaceutical Products,
CONTACT No.73, June 1983.
7.
8.
The Use of essential Drugs, WHO Tech Report Series 722 (1988)
Tonics, How Much an Economic Waste, Kamala Jaya Rao,
medico friend circle bulletin, November 1976.
9.
The Dangerous Drug List, Claude Alvares, Illustrated Weekly
of India, 12 July 1987.
10.
Formulary and Therapeutic Guide, Kurji Holy Family Hospital
January 1983
Items 1,
2, 7, 8,
10 available from VHAI,
South of IIT, New Delhi 110016.
40 Institutional Area,
18
T)p. - lLj-
THE HINDU, Sunday, August 25, 1985.
X
Crosadfer agamst
dragamperiaOsm
R. ZAFRULLAH Chowdhury, who won
this year's Ramon Magsaysay award for
community leadership, said he would continue
his struggle against multi-national and other pro
fit-mongering international drug companies,
"who exploit the developing Third World counIries like Bangladesh by pursuing their policy
of medicine-imperialism';
Dr. Chowdhury, the 43-year energetic Bangla
desh physician, who in 1972 founded the "Gano
-Sasthya Kendra" (Peoples Health Centre), a
medical service complex mainly for the rural
poor, at Savar, some 35 km off the capital city,
told this correspondent in an exclusive inter
view in Dhaka that he was "happy" with the
news of the Magsaysay award.
"I am particularly happy that the cause for
which we in Bangladesh are fighting has been
recognised by the international forum. This is
a recognition of our war against multi-national
exploiters who trade on the ignorance of the
millions of suffering humanity." Dr. Chowdhury
said adding, “but we still have to go a long
way to materialise our dream".
A freedom fighter in 1971's war of liberation,
Dr. Zafrullah Chowdhury, who had become
one of the most debatable men in Bangladesh
not only for his role in the medical service but
also in politics (although he is not a member
of any political party) was given the prestigious
Ramon Magsaysay award worth U.S.$20.000
and a gold medal in recognition for engineering
Bangladesh's new policy on pharmaceutical
drugs and making comprehensive medical care
available to ordinary people.
Restless
and
mobile,
Dr.
Zafrullah
Chowdhury, during his student life in the Six
ties. was an activist against Field Marshal Ayub
Khan's regime, and later known in the country
as a man of “progressive political line". During
the liberation war in 1971, he was in London
doing FRCS degree but he left U.K. along with
some of his friends to join the war.
D
A man of serious conviction and action, Dr.
Chowdhury came to India in the midst of the
war and started a field-hospital near the Indo
Bangladesh border to treat the wounded free
dom fighters. After the independence of the
country In December 1971, he shifted his small
war-time hospital at Savar and began his work
by constructing a small building after getting
a donation of an acre of land from two local
phllanthrophists.
Within 13 years, the energetic Chowdhury
spread his projects over 40 acres of land and
his "Gano-Sasthya Trust" has been expanded
to a great extent. At present. Dr. Chowdhury
has 23 self-reliant units where over one
thousand people work. He employs over 65
per cent women, mostly from the poorer sec
tions of society, in his projects including the
"Gano-Sasthya Pharmaceuticals Ltd"—which
has become one of the leading medicine pro
ducing industries in the country within few
years. His philosophy to recruit a higher per
centage of women in his projects was that the
women, who constitute half of the country's
population, are the most exploited and they
should get proper support to stand on their
own feet.
One of the specialities of Dr. Chowdhury's
projects Is that all these are designed and run
on a self-reliant basis. The "Gano-Sasthya
Trust", among others, has health magazine publi
cations. printing, agriculture, confectionary.
cloth, shoe and furniture producing units. The
people who work are all treated equal. There
is no bureaucratic structure. All workers, includ
ing Dr. Chowdhury, eat the same food and get
the same standard of accommodation. "GanoSasthya Kendra1 is a 'socialist' complex where
Dr. Zafrullah Chowdhury Is teaching his “self-de
signed socialism", In the very functioning of
the complex.
There
Is another speciality of Dr.
Chowdhury, In that the people who intend to
Dr. Zafrullah Chowdhury
work with "Gano-Sasthya Projects" should be
non-smokers. All the workers must get up in
the morning and work in the field for a specific
time before going to their respective units. All
the women workers in the project must know
how to ride a bicycle. They must move from
door to door in the villages to motivate people
about the primary health care. In the initial days.
Dr. Chowdhury's plan to send women into the
villages on bicycles was vehemently opposed
by many people. But now they have realised
the usefulness of the women "Gano-Sasthya
" workers, who educate the villagers not only
in matters of health but also helps them to in
crease their farm output.
Dr. Chowdhury's "Gano-Sasthya Pharma
ceuticals", during the last two years, has been
producing almost every essential drug and has
become a competitor of the big multi-national
companies. "I have been a target of the medic
ine-imperialist because I wanted to help my
people by supplying them with cheaper and
more useful medicine." he said.
In 1978's Presidential elections. Dr. Zafrullah
Chowdhury played a pioneering role in nominat
ing General Ataul Ghani Osmany. a retired
General and the Commander-in-Chief of the
Bangladesh liberation forces in 1971, as the
principal candidate against the President. Lt.
Gen. Ziaur Rahman. Although Dr. Chowdhury's
nominee failed to win the electoral battle, he
successfully projected his political views
throughout the country. With this direct in
volvement in politics, Dr. Chowdhury, who until
then was known mainly as a "Crusader" again
st the multi-nationals in the pharmaceutical sec
tor. also became known in the political arena.
While explaining his past political role, the
Magsaysay winner told this correspondent "...
I was trying to establish a cause—a justice.
that is. cheaper and easier health care to the
poorest section of our society. Our poor and
simple hearted people had been exploited by
the multi-national giants for many years. I could
not succeed earlier because there was no politi
cal support. Well. I am not at all out of politics
as I believe that without political backing it
would be very difficult to implement my ideas.
So. I supported and worked for Gen. Ataul
Ghani Osmany in the Presidential elections..."
The Magsaysay award winner, however.
thanked President Lt. Gen. Hussain Mohammad
Ershad for his government's "sincere will" to
frame and implement the much debatable Na
tional Drug Policy. With the new drug policy
the military regime of Gen. Ershad has drastical
ly banned over 300 drug items overnight des
cribing them as "useless and injurious to
health".
Dr. Zafrullah Chowdhury, who was in the
eight-member committee to frame the new
drug policy said. "... We also tried persistently
to frame and implement such a drug policy
during the time of the former government, but
failed. I must thank President Ershad for his
sincere will in this regard and. of course, his
government's courage to implement it despite
repeated threats from very powerful external
quarters". If I do not praise Ershad it would
be a distortion of historical facts".
The debatable drug policy of Bangladesh
which was approved by the Council of Ad
visors of Gen. Ershad on May 29, 1982 and
acclaimed in many quarters was still under pres
sure. Dr. Zafrullah Chowdhury was not just a
member of the committee, but played a vital
role in its framing and implementation. He said
that the new drug policy was not only an
“achievement" of the present government but
also "a step forward" in providing cheaper medical service to millions of people who suffer
from malnutrition and die of simple diseases
for want of medicine. "The medicine industry
should not be compared with the industry
which produces warheads. It should be a ser
vice-oriented industry and the companies
which are involved should stop trading on
human miseries." Dr. Chowdhury remarked
Dr. Zafrullah Chowdhury married a German
-5uh> ce-nlve^-twl pl rug s
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JV • IsoSoJrbid-e U i hiHvcde. AcxMcAs.
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*
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3 |. I vaj . D i
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correct
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-
10
MORBIDITY AND MORTALITY PROFILE OF KARNATAKA AND REQUIREMENT
OF ESSENTIAL'DRUGS FOR PRIMARY HEALTH CARE_________________________
*Vasundhra.M.K.
The State of Karnataka with a population over three crores
consists of twenty districts as administrative upits.
The demo-
—graphic profile and the availability of health care institutions
are indicated in Table.1 .
The incidence and deaths during the
year 1988 (Table 2) indicate that the communicable diseases pre
dominate as cause of sickness as death.
Tuberculosis, Acute
Respiratory Infections, Diarrhoeal Disorders and Malaria are
priority areas.
increasing.
The incidence of P,Falciparum infection is.
The vaccine preventable diseases are at high and
unacceptable level.
The viral infections of public health
importance are measles, Japanese Encephalitis and K.F.D. which
is peculiar to Karnataka.
The most affected age group is below
15 years and the average number of episodes per person per
year is 3.
The nutritional disorders include anaemia, protein-energy
malnutrition Vitamin A deficiency and endemic goitre.
The noncommunicable disorders like ca .cer, Cardiovascular diseases and
accidents are increasing.
Majority of cancers consist of
Carcinoma of Oesophagus among males and carcinoma of cervix among
females.
53.2% of cancers among males and 37.0% of cancers
among females are tobacco- related and thus preventable.
The management of these maladies need judicious use of
drugs thereby saving resources - both human and financial.
The practice of drug utilisation in the country - Karnataka
being no exemption - presents a pathetic pieture.
(1)
All drugs are not available to everyone as and when needed.
(2)
The available drugs are not appropriate as these do not
(3)
The fraudulent practices help pump spurious drugs in the
(4)
The avaiability of a large number of drugs under various
meet the health care needs of the majority of community.
market.
brand names (70% drug) confuses both the practitioner and
the patient.
'
i
Aggressive advertisements, colourful and
* rofessor
P
and Head of Department of Preventive and Social1.
Medicine, Bangalore Medical College, Bangalore.
2
high-sounding literature along with additional incentives by
pursuasive sales representative tend to push new drugs across
the doctor's desk.
Few doctors pause and question the desir-
-ability of a new drug.
The incidence of Iatrogenic disorders
is on the increase.
(5)
The poly pharmacy is a common practice in the fond
hope that atleast one of the prescribed drugs would be therapu—
-tically effective.
Our study of drug prescription by medical
officers indicated preference of three drugs on an average per
disorder.
Even the self-limiting drugs are treated aggressively.
This "shot-gun therapy" damages both the patient and his pocket.
(6)
The transnational companies continue to dump drugs
of doubtful value in developing countries.
Precious foreign
exchange is thus lost (40% of total health budget) on acquiring
these drugs thus straining,. the already constrained economy.
O
There is little available for preventive and prentive and promotive
measures.
(7)
The poor patient compliance calls for the need for
informed public.
(8)
The availability of OTC drugs promotes self ad-
-ministration.
Very often the experienced patient prescribes
dangerous prugs to fellow beings.
.
(9)
The drug indents are often place on basis of previous
drug indents which neither meet the needs of the community nor take
into consideration the changing demographic profile/ availability g
health facilities training status of the community and the budget
provisions.
Essential drugs should not only be theraputicglly effective
and reasonably safe but should cater to the health care- needs of
the majority of the population, being available at all time
ensuring adequate quantity and quality.
The accessibility of
drugs within one hour walking distance and inclusion of local
traditional medicines of proven theraputic value would ensure
its acceptability by the community.
Rationale use of drug needs
continuous monitoring and evaluation.
y
T
* he
drug indents should be place on basis of morbidity nrofile,
3
The drug requirement will vary at various levels.
An
attempt is made herein to enlist the most essential drugs at
village sub-centre and P H C level (Table
).
The pharmaceutical supply systems is thus one of the most
critical issues of primary health care in our country.
concern should,
therefore, be to provide the right drug,
right dosage, at right place in right time.
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■
10
KERALA
Area
=
38,864 Sq. Km
Districts
=
14
Taluks
=
61
Villages
=
1451
Develop Blocks
=
151
Panchayatts
=
999
Municipalities
=
44
1
Township
=
Muncipal Corporations
=
3
Population
( 81 cencus )
=
254.5 laks
Estimate 1990
=
296.7
Density of population _
per Sq. KM
655
Total literacy
=
70.42%
No. of M.C
=
5
No. of Govt. Hospital =
159
Private/Local bodies
=
1894
Total
=
2 05 3
=
73684
=
4374
Community H.C
=
29
Average population
served by ;
Sub Centre
H.
f.
Centre
C.H.C
=
=
=
5268
31913
764000
Total No: Beds
No. of PHC
722
■ Sub centres
Per capita expenditure
on Med. & Public Health
17.3%
Budget
Rs. 60/-
(86-87)
Birth Rate
=
19. 9
Death rate
=
6.2
27
IMR (1988)
M.M.R
=
1.3
Couple protection rate=
58
Life expectancy:
Male
Female
67
70
Dr. D.K. Nair
Drug Controller
KERALA.
"
=
=f
m/pd
27690
DEMOGRAPHY
1.
Total population of India
:
6851.8 lakhs
2.
Total population of A.P.
:
53549673
3.
Andhra Pradesh Contains
:
27379 villages
4.
By 1-1-1988 In A.P.
:
1083 PHCs
6994 Subcenters
31 Upgrade PHCs
34 Tribal Area PHCs
HEALTH MANPOWER IN PRIMARY HEALTH CARE
(Number of persons trained upto 31-3-1987 in A.P.)
Medical Officers (at PHCs)
:
1399
Multipurpose workers (M)
:
7946
Multipurpose workers (F)
:
6860
Health Assistants (M)
:
2718
Health Assistants (F)
:
1415
Health Guides
:
35624
Dais
:
441Mb
TOTAL HOSPITALS & BEDS IN A.P.
Hospitals
Buds
Rural
165
3716
Urban
450
32684
Total
615
36400
VITAL STATISTICS
Estimated Annual Birth Rates In A.P. per 10U0 Population
>
Combined
Rural
Urban
: xra v. r* ras rss re rs m
—: rrx t x st: rrt. t= trs «=
t=i sn iru c -.
1983
1984
1985
1986
30.8
31.5
28.4
31.2
31.4
30.6
29.9
29.8
30.2
31.6
32.4
28.7
ca r n «= ex •:: i cu =cc T= » -> e-.:
x« I.'S It? >r. .« ch l—
as !s»;h la :sr. tra
:ra d : : era <u ci
Estimated Annual Dealt) Rates In A.P. per 10011 pnpiilai Inn
Combined
Rural
Urban
1983
1984
1985
1986
10.4
11.2
7.2
11.0
11.7
8.6
10.3
11.1
7.3
9.9
10.7
7.1
INFANT MORTALITY RATES IN INDIA (Per 1000 I Ive births)
1982
1983
1984
1985
1986
1988
Rural
Urban
Combined
114
114
113
107
105
65
66
66
59
62
105
105
104
97
96
98
INFANT MORTALITY RATES IN A.P.
1972
1978
1980
1986
Rural
Urban
Combined
128
120
103
87
65
62
40
59
116
112
. 92
82
AGE SPECIFIC DEATH RATES IN INDIA (1984)
Age Group
0 - 4
5 - 9
10 - 14
Rural
Urban
Male
Female
Male
Female
53.2
5.0
2.2
59.3
5.4
2.3
31.1
2.4
1.6
33.3
2.9
1.2
EXPECTATION OF LIFE AT BIRTH (YEARS)
E0
1951-61
1961-62
1980
India
A.P.
41.62
36.9
41.7 '
44.4
54.4
55.7
MORTALITY & MORBIDITY PROFILES
REPURILD CALLS & DLA1IIS UUL IO SUMI. DILI ALLS
A.P.
INDIA
Cholera
‘
"
Dysentery
G.E.
Diptherla
Whooping Cough
Tetanus
Measles
Polio
Tuberculosis
Enteric Fever
Chickenpox
Influenza
Viral Encephalitis
Viral Hepatitis
Meningococcal Infection
Rabies & Dog Bi-tes
Cases
Deaths
Cases
Deaths
11423
8741081
1338594
10057
162506
29167
228166
22021
224
2109
462 1
329
76
4522
639
708
206
954741
747 //
737
24469
3505
. 19644
3484
125789
18543
1339
216817
1956
11109
2580
1349
11
290
659
23
12
486
64
66
1182
37
2
9
295
128
■ 90
126
SEASONAL INCIDENCE OF CERTAIN DISEASES
III QUARTER IV QUARTER
I QUARTER
II QUARTER
Jan Feb Mar'
Are w nyJ Jul 30$ SGT ocT Ajoif dgc
UXOCQOC
Diarrhoea
1066
Encephalitis
80
Pyogenic Meningitis
102
Pneumonia
165
Nutritional Disorders
294
Rheumatic heart disease 41
Septicemia
60 .
AGN & Nephrotic Synd.
62 '
Tuberculosis
112
Bronchltls/Bronchlolltis 92
1428
69
91
135
240
28
85
56
93
80
1261
82
111
105
267
49
70
89
94
111
998
101
100
126
245
45
73
60
124
100
PROFILE OF COMMON DISEASES IN INDIA
1.
2.
Polio Myelltles:
- In A.P., prevalence rate of pollo/1000 children In 5 to
9 years age : Rural = 6.4; Urban = 5.3
- Percentage ol Pollu Myelltles as cause ol lameness
A.P. Rural - 49.4; Urban - 66.8
In
- Annual Incidence of Polio Myelltles/100 children in
to 4 years. Rural = 1.7; Urban = 1.4
0
Tetanus:
- Estimated mortality rate from tetanus Is
Rural - 13.3/1UUU live births
Urban- 3.2/1000 live births'
- Nealry a quarter million infants died in first month of
life.
3.
Pertusls:
- Around 3 lakh cases reported annually
4.
Measles:
Estimated no. of cases was 0.96 millions in 1977.
case fatality rate is 1 to 3 percent.
5.
Tuberculosis:
- 10 million patients in India.
- A quarter of them are Infectious.
- 5 lakh deaths occur annually from T.B. Most of them
children below 15 years.
The
in
6.
Diarrhoeal Diseases:
- About 10% of total infant deaths are due to diarrhoea.
- An estimated 1.5 million children under 5 yr die of it.
7.
A.R.I.:
- Over 17% of infant deaths are on this account.
- Upto 40% of O.P. patients and upto 35% of Inpatients
are children below 5 years.
- Case fatality rate is 10 to 16%.
8.
Rheumatic Heart Disease:
- Estimated prevalence rate is 6/1000 population.
- About 2 million children between 5 & 15 yrs of
suffer from rheumatic fever and R.H.D.
age
9.
Hookworm Infestation:
- The south, east & west coasts of India ■ are
infested. Of 359 million affected in Asia, 205
are in India.
10.
Fllarlasis: About 14 million persons have it. A larger
No. are micro filaria carriers. 304 million in endemic areas.
- .
heavily
million
Nil I IM I INN
Percentacie Distribution of Malnourished Children 1-5
(1980) G(JMEZ
India
A.P.
years
N
Normal
90%
Mild
75-90%
Moderate
60-75%
Severe
60%
4008
883
14.8
14.7
47.9
49.4
32.6
32 .-1
4.7
3.9
NUTRITIONAL DISHRDI RS'
1.
Protein Energy Malnutrition:
- Severe PEM (Marasmus & kwashlorkar) is seen in 1-2%
children of preschool age.
- Around 60-70% of children suffer from mild or
degree of PEM.
- In urban slums over 26% of children
severe PEM (IJMR 68; 17-23, 1978).
2.
of
moderate
suffered
from
Nutritional Anemia:
- In children It Is 66.3% in rural areas of A.P. (HYD).
- 50% among children of preschool age (ICMR, 1981).
3.
Vitamin 'A' Deficiency:
7.2%
‘in
- Around 300000 new cases of xeropthalmla, about half
which result In blindness occur each year in India.
of
- Around 300000 children go blind
serious vitamin 'A' deficiency.
to
- In A.P. prevalence Is 1.4-1.5
preschool, 17.4% In 5-12 years.
4.
In
Infants
each
year
due
Iodine Deficiency:
- About 40 million people are estimated to have iodine
deficiency disorders among them 1 million cretines
(AIM,' 1984).
NUTRITION
NliWS
Vol. 3.
No. 4.
PERCENTAGE PREVALENCE OF VITAMIN-A DEFICIENCY*
IN PRESCHOOL CHILDREN - INDIA
Source: NNMR Reports 1979-1981, National Institute of Nutrition, Hyderabad
500 007, India.
NUTRITION NEWS
Percentage Distribution or Malnourished Children 1-5
(1780) GOMEZ
India
A.P.
Vol. 3.
years
N
Normal
90%
Mild
75-90%
Moderate
60-75%
Severe
60%
4008
883
14.8
14.7
47.9
49.4
32.6
32.1
4.7
3.9
No.).
TRENDS IN NUTRITIONAL GRADES OF PRESCHOOL CHILDREN
(Source: NNMb Hural Surveya. 107b-aO)
ANDHRA PRADESH
TAMIL NADU
MAHARASHTRA
KARNATAKA
KERALA
1W75 IV/6 IV// 1V/6
1V/V IV60
PRIMARY HEALTH CARE
"Primary Health Care Is 'essential health care made
universally accessible to Individuals and acceptable to
them, through their full participation and at a cost the
community and country can ollured."
"It is the key to the attainment of health for all
2000 A.D."
Elements:
- Promotion of food supplies, proper storage and
nutrition.
- Education about health problems and their control.
- Safe water supply and basic sanitation.
- Mother & child health and family planning.
- Immunization against Infectious diseases.
- Prevention & control of locally endamic diseases.
- Treatment of common diseases and Injuries.
- Provision of essential drugs.
by
proper
Essential Drugs:
Essential drugs are those that satisfy the health care
needs of the majority of population & should be available at’
all .times in adequate amounts and the appropriate dosage
forms.
Introduction: The selection of essential drugs would depend
on the health needs and on the structure and development of
health services of each country, and the lists of essential
drugs should be drawn up locally and periodically updated,
with the advise of experts in public health, medicine,
pharmacology, pharmacy and drug management.
Guide Lines for Establishing a National Programme:
- It is based on the recommendations of a local committee
which Include Individuals competent In various fields.
- The international non proprietory (generic) names for
drugs or pharmaceutical substances should be used whenever
available.
- Conslse, accurate and comprehensive drug
information
should be prepared to accompany the list of drugs.
- Quality, inlcudlng stability and bio availability should
be assured through testing or regulation.
- Finally the success of entire programme is dependent upon
the efficient administration or supply, slurage
and
distribution at every point from the manufacturer to the
end user.
Criteria for the Selection of Essential Drugs: Depend on
- Pattern of prevelent diseases.
- The treatment facility.
- The training and experience of the available personnel.
- The financial resources.
- Genetic, demographic and environmental factors.
ESSENTIAL DRUGS IN PRIMARY HLALIII PARE
The basic list ul essential drugs under primary lieallli
care 'should be baser] on the dll Cerent levels of health
SeiVlces"pfl)vlded, "and1 competence' of functlonar les Involved
In' it1:' wlm'|lv III1 j!erni"kih(l111’l1 be'liascil on morbidity pattern In
fhrfwMahri-siW: wmiwai,d lusl 01 Liiu
The following factors will Inevitably Influence the
cg^ef]["'pf' fhe'esse^igl drugs list 10 primary health care.
]. Jhe National Health Infrastructure:
The type of primary health care service that a country
requires 1 ib1 dependent-upon the proximity and nature of the
first1 referral1,TatPil'ities'."' 1,1
1 '■ ••
I I I •. f
I I I r( l j I
I .,1
I I I I I I
2. Training and Sippiles:
/. Irani Hu; ;.iini S Ip,)T 11:
The numbers of trained personnel, the facilities placed
at tpe''th'yi?'dIsposaJJ.» !and the supplies entrusted to' them
determine!'bdth'lthd"scope and1 the limitations' of the primary
nbal'tti
'db're"sysfe(n. J ■"
1 ’T-Tr
■ " T r 11 r-rrr r -.7 ■.; 1 ni.
t
Workers wltfi one or more years vocational training can
opvlouS'ly' 1 accomplish mbrfe"than1 personnel who rely upon 1 an
1'rttdribive cdurse!'of practical instruction lasting only-a few
Weeks.1 1 But""whatever 1 the "circumstances little 'can 1 be
accomplished Uhlfess1 1 continuity of essential supplies and
infoirmatibnillsliaSsured'.'"111
1! ■ 1,1 ■
1111, hi in.. I 1 t,ii
r.
.r.'.ii 1 i-i.i.
3.
The
Pattern of Endemic
Diseases:
'• .
I III' I’.I i I i'f II III
I ill. I ;,i ! 1
.!■
The
prevalence of major endemic
infections
and
parasitic diseases1may'vary from region tn region within
pui'iii t rik"1 * In
’1 1 conf I'fin 11, y '
1 ’wll.li"
wll.lr" 1 cTlmnl.lc,
cl Imnl. Ic.
ucnurnpii In
poi'intrY
liiconfIfinll.y
ui'iigrni'iiiiinik
tupudraphleul, soulal1!1 1 bcunumlc^und1 occupi.il. |.nni.il fiicl.iirs , •> •
I n| 'i nJ 1 ., 1 Hi I i.i I ,
sin' 1.1 I ,
1 1 1H H 'hi ■ 1
.nd ii;.,
■ ■ 1 ., .
Careful planning and, In some cases, epidemiological
surveys'‘‘are required11 to"ensure that the most effective' and
useful drugs' are 'provlded' and to:iobtaln full benefit from
lllmltlng,|rB9oiircBSi."1,1 •'
'
11
I liu I r Ini] 1 i".mu 1 i",.
THE
LEVELS
OF SERVICES
IN.. PRIMARY
HEALTH CARE
mi
11 v, r. in
j.
i
■'
... .
a)
b)
c)
d)
Anoanwadl worker
Vil'llage'ihea'lth'-gulde '
Sub'centre 11n 'm m
Prilmary 1 health centre
1 i > I' t I Hi, 11 y 111 '.1 1111 1 1 j 11 1 1 ■
I. Essential Drugs Suggested
for the kit of
A.W.W./
village health guide.
- Vitamin 'A' solution
- Iron A folic acid tablets
- ORS packets
- Chloroquine tablets
- Paracetamol tablets
- Mebendazole tablets
- Chlorpheneramlne maleate
tabs
- Gentlon violet granules
- Borospirlt ear drops
- Terramycln eye ointment
- Benzyl benzoate emulsion
- Cotrlmoxazole (Tb & Syp)
- Zinc sulphate eye drops
- Chlorine tablets
(for chlorination of water)
- Salbutamol syp.
III.
Essential’ drugs
subcentre
at
the
A. Drugs suggested
A.W.W./V.H.G.
for
the
II
B. Additional drugs:
Aspirin
Metoclopramide
Contraceptive pills
Tab & Inj methergin
Activated charcoal
Essential drugs at tlw primary health
A. .Drugs listed for subcenlre
B. Additional Drugs
- Pencillin (Procaine &
Benzathine)
Amoxycillin Syp.
Chloramphenicol
Digoxin
Dihydr all az in e
Isosorbide dlnltrate
Phenobarbitone
Promethazine syp.
Glybunclamlde lab.
Furazolldine
Metranldazol
Theophylline
Aluminium hydroxide
B complex
Vitamin D
Diazepam
Antltubercular drugs
(available under NTCP)
antileprosy drugs
(available under NLEP)
Dlethylcarbamazlplne
Isoxsuprlne HCL
Povldlne iodine vaginal
pessary
Tab prednisalone
Furosemide
Tincture iodine
- Whitfield's ointment
- xylocalne 45K, 2% & gelly
- Inj. Aminophylline
- Inj. Adrenaline
- Inj. Dexamethasone
- IV Fluids
(Ringer Lactate
5% dextrose
5% dextrose saline)
- Ind. Normal saline
- Inj. Sodium bicarbonate
- Inj. Potassium chloride
- Inj. Oxytocin
- Vaccines & Sera
DPT
()PV
Measles
Anti rabies
Anti snake venom
WORKOUT
FOR ESTIMATION & UTILISATION OF DRUGS ACCORDING
SEASONAL TRENDS
TO
I. Acute Diarrhoeal. Diseases:
Total admissions into our hospital pur year - 4/53 casus
Per each admission case we expect 10 cases in OP
100 cases in community
The average amount of drugs needed for each diarrhoeal
episode for O.P. cases
Tab. Furoxone 'Tt.d.s (9 tabs)
’for 3 days'
ORS 2 packets
Cost of treatment for each case: Furoxone tab. (0.25p)
ORS packet
(1.25)
for 3 days
Total
= Rs. 4.75
Total No.of cases expected In O.P. per year'
- 47530 •
Total costs of drugs per year for O.P. cases
- 47530 x 4.75 - 2,25,767..50
Total No.of cases In community = 4,7'5,000
About 80% of them will be having mild diarrhoea for
which we ciin advise home remiujles like suonr-si.il t solution,
rice based ORS and lemon salt sugar solution.
By this only 20% of cases In community
treatment (95,060 cases).
For each case treatment:
need
drug
As utilisation factor is about 60%, the amount of cost
communit is Rs.3,42,216 per year.
for
tab. sulphaguanidine (6)
tab. furoxone 1 t.d.s (9)
ORS packets
(2)
lotal cost Rs.6/- pur case
for 3 days
For total community cases = 97,060 x6 = 5,70,360
II. For acute respiratory infections:
Total admissions of A.R.I. in our hospltal/yr = 1,337
For each admission case we expect 5 cases in O.P.
50 cases in community
The average amount of drugs needed for each episode for O.P.
Tab. Cotrlmoxazole (10) Rs.7/-; Total OP cases = 6,685
Total cost for OP cases ■= 6685 x 7 = 46,795 per year
For community;
ToTaT“ cases - 66,850. Among them 80% doesn't need drug
treatment. So only 20% cases (13,370) need treatment.
Total cost = 13370 x 7 = 93,590 Rs.
As utilisation factor is about 60%, the amount of
investment for community per year = Rs. 56,154/year.
NATIONAL INSTITUTE OF PUBLIC CO-OPERATION &’ CHILD DEVELOPMENT
Regional Workshop on Essential Drugs In
Primary Health Care
( 27 - 28,
June,
PROGRAMME
Wednesday,
27th June,
9.00
a.m -
9.30
a.m - 10.00 a.m
1990 )
SCHEDULE
1990
Registration
9.30 a.m
Opening Session
10. 00 a.m - 10.30 a.m
:
COFFEE
10. 30 a.m -
1.00 p. m
;
Review of Morbidity & Mortality
profile of each State &‘Essential
Drugs in Primary Health Care
a.m - 11.00 a.m
:
i)
111.30
Karnataka
- Dr.M.K. Vasundhara
Bangalore Medical College
Bangalore
11.00 a.m - 11.30 a.m
?
ii)
Andhra Pradesh
- Dr. M.V.G. Subramaniyam
Tirupati
11.30 a.m - 12.00 poon
; iii)
Kerala
- Dr.K. Rajan
Medical College
Alleppey
Kerala
12.00 noon- 12.30 p.m
s
iv)
Tamil Nadu
- Dr. A. Parthasarathy
Institute of Child Health
Egmore, Madras
2/-
2
:
12.30 p.m - 1.00 p.m
v)
Pondicherry
- Dr.P. Rajaram
D^an
JIPMER
:
1.00 p.m - 1.30 p.m
vi)
Goa ■
- Dr.S.B. Dixit
Professor & Head,
Goa Medical College,
Goa.
LUNCH
1.30 p.m - 2.30 p.m
;
2.30 p.m - 5.00 p.m
Discussion in Sub-groups on
i)
Essential Drugs for AWW/VHG Kit
ii)
Essential Drugs at Sub-Centre
Level
iii)
Essential Drugs at P.H.C Level
iv)
Drugs requirements for 1000
population
v)
Budget for Essential Drugs
vi)
vii)
m/pd
26690
Drug Supply System
Important guidelines for
consumers
Thursday,
28th June 1990
9. 00 a.m.
- 10.30 a.m.
;
Discussion Continued
10.30 a. m.
- 11.00 a.m
:
COFFEE
11.00 a.m
-
1. 00 p.m
:
Presentation & finalization of
Group Reports
1.00 p.m.
-
1.30 p.m
:
Concluding Session
1.30 p.m
-
2.30 p.m
:
LUNCH
3. 00 p. m
-
4.00 p.m
:
Disbursement
of T. A
NATIONAL INSTITUTE OF PUBLIC COOPERATION AND CHILD DEVELOPMENT
Southern Regional Centre, Bangalore.
REGIONAL WORKSHOP ON ESSENTIAL DRUGS IN PRIMARY HEALTH CARE
BANGALORE,
27 - 2STH JUNE,
1990
LIST OF PARTICIPANTS
1.
Dr. V.R. Parvathi
Addl. Prof Paediatric
Madras Medical College
Paediatrics Institute of Child Health
& Hospital for Child
Madras - 8
No. 10 Halls Road, Egmore, Madras-8.
2.
Dr(Mrs)
Chandra
Director, Institute of Soci-al Paediatrics
Prof & Head Dept, of Paediatrics
Stanley Medical College
Madras - 1.
3.
D ■. K.J. Mathew
Director & Professor
Dept, of Community Medicine
Medical College, Kottayam
Kerala - 686008
'
4.
Dr. P.V. Aswath
Professor and Head'
Dept, of Preventive & Social Medicine
Karnataka Medical College,
Hubli - 580022
5.
Dr. Teresa Lopez
Associate Professor of Paediatrics
SAT Hospital
Trivandrum.
6.
Dr. Leela Itty Amma
Asst. Professor
Dept, of Community Medicine
Medical College Kottayam
Kerala.
7.
Dr. A. Chandra Bhushanam
Additional Professor of Paediatrics
Deptt.of Paediatrics
Stanley Medical College
Madras - 600 001.
8.
Ms. Karuna Behl Bishnoi
Project Officer, Health
UNICEF, 73 Lodi Estate
New Delhi.
...
2
2
9.
10.
Dr. D. Kumaran Nair
Drug Controller
Office of the Drugs Controller
Govt, of Kerala
Trivandrum - 695 037
Dr. T. Kamal Sheriff
Professor & Head
Dept, of Community Medicine
Stanley Medical College
Madras 600 001.
11.
Dr. P.G. Sivananda
Deputy Director
Office of the Director of Public
Health. 295 Anna Salai,
Madras - 6.
-12.
Dr. Manjula Dixit
Chief Medical Officer
Central Hospital Tisea,
Usgaon,jGoa.
13.
Dr. S.B. Dixit
Prof Sc Head
Dept, of PSM
Goa Medical College
Bambolim - 5 (GOA)
14.
Dr. S. Srinivasaii
Professor & Head \
Dept, of Paediatrics
JIPMER
\
Pondicherry. 6
\
15.
Dr. M.V.G. Subramanyam
Prof & Head
Dept, of Paediatrics
S.V. Medical
College
16.
Dr. C.H. Shashindran \
Associate ■: Prof essor
Dept, of Pharmacology
JIPMER
Pondicherry - 6.
17.
Dr. M.K. Vasundhra
Professor Sc Head (PSM)
Bangalore Medical College
Bangalore.
\
Tirupati"- 7.
3
3 18.
Dr. K.A. Narayan
Associate Professor
Dept, of Preventive & Social Medicine
JIPMER
Dhanvantri Nagar
Pondicherry -6.
19.
Dr. R.P. Augustin Paul
Deputy Director (Public Health)
Govt, of Pondicherry
Directorate of Health and
Family Welfare Services'
Pondicherry.
2 0.
Prof. P. Rajaram
*
Director & Professor
Dept, of Obstetrics & Gynaecology
JIPMER
Pondicherry - 6.
21.
Dr. N. Krishna Chandra
Training & Evaluation Officer
UCD Project (ODA)
Municipal Corporation
Vishakapatnam.
22.
Dr. A. Parthasarthy
Assoc. Prof' Of^Paediatrics
Institute of Child Health
Madras - 600 00i.
23.
Dr (Mrs) Nalini P Pai
Prof and Head (PSM)
TNMC - Bombay
24.
Dr. K. Jagadheeswaran
Senior Medical Officer
JIPMER Rural Health Centre
Raman athapurarr.
Pondicherry - 4.
25.
Dr. K.N. Prasad
Tutor
Dept of Community Medicine
Kasturba Medical College
Manipal.
26.
Dr. S.P. Sarkar
Asstt Commissioner (t)
Ministry of Health & ^amily Welfare
Nirman Bhawan
New Delhi.
4
27.
Dr. B. Swarajyalakshmi
Health Consultant (SIP)Visakhapatnam Muncipal Corporation,
28.
Dr. T.P. Gandhi
Consultant ICDS
Civil Surgeon Paediatrics
Visakhapatnam.
29.
Dr. K.R. Antony, Medical Officer
The Catholic Hospital Association of India
Secunderabad 500 003.
30.
Dr. Shirdi Prasad Takur
Paediatrician
Community Health Cell
Bangalore - 1.
31.
Dr. Korrapati Madhusudana Rao
Asst. Prof of Pharmacology
Siddhartha Medical College
Vijayawada 520 005.
32.
Dr. Y. Sree Hari Rao
Prof of Social & Preventive Medicine
S.V. Medical College
Tirupati
33.
Dr. R.S. Phaneendra Rao
Professor
Deptt. of Community Medicine,
Kasturba Medical College
Manipal 576 119.
34.
Dr. D.K. Srinivasa
Professor & Head
Deptt.Social & Preventive Medicine
JIPMER
Dhanavantri Nagar
Pondicherry - 6.
35.
Dr. K.B. Makapur
Joint Director (Health Education & Training)
Directorate of Health & Family Welfare
Services
Bangalore - 9.
36.
Mr. Ramesh Halbhavi
Programme Officer (ICDS)
d/o the Director of Women & Children's
Welfare
1st Fl, M.S. Building
Dr. Ambedkar Road,
Bangalore - 1.
5
37.
Dr. G. Nagaiah
Medical Officer
Rural Health Centre
Patancheru
Madak Distt
Andhra Pradesh
38.
Dr. C.M. Francis
Director
St. Martha's Hospital
Bangalore - 9.
39.
Dr. (Mrs) S.U. Warerkar
Dean ..
Dr. V.M. Medical College
Solapur 413 0031
40.
Dr. V.V.R. Seshu Babu
Professor & Head
Deptt._of Social & Preventive Medicine
Kakatiya Medical College
Warangal - 7.
41.
Dr. B. Balaram
Medical Officer
Primary Health Care
SuBhannagEr
Khammam Dist
Andhra Pradesh - 507 123
42.
Dr.s ,h . Naikwadi
Asst. Surgeon
Bangalore Medical College
Bangalore.
43.
Dr. S.Y. Shrikanth
PG Student
Bangalore Medical College
Bangalore.
44.
Dr, (Smt) Radha Ramesh
PG Student
Bangalore Medical College
Bangalore.
45.
Dr. S.R. Desai
Asst. Drug Controller
O/o the Drug Controller
for the State of Karnataka
Palace Road
Bangalore.
46,
Dr.Gopal Dabade,
Drug Action Forum Karnataka,
57, Tejaswinagar,
DHARWAR - 580 002.
47.
Dr.Mira Shiva,
Head of Division,
Peoples Education for
Health Action,
V H A I,
NEW DELHI.
ntpccd, "Faculty.
48.
Dr.(Mrs.)L.Meera Patankar,
Joint Director (CD),
N I P C C D,
NEW DELHI.
49-
Dr.A.M.Khan,
Regional Director Incharge,
NIPCCD, Regional Centre,
BANGALORE.
50.
Dr.Dinesh Paul - Programme Director,
Deputy Director (Health),
NIPCCD,
NEW DELHI.
51.
Dr.(Mrs.) Neelam Bhatia Programme Associate'
.
Research Assistant (Health),
NIPCCD,
NEW DELHI.
I DRUG DEPENDENCE - THE DEAD END
January 1991
INFORMATION KIT
Message from Dr U Ko Ko
Regional Director, WHO South-East Asia Region
or thousands of years man has been using substances that have psychoactive effects. In some regions and countries,
the use of such substances was closely linked to rituals and prevailing socio-cultural practices. For example, opium,
F
coca leaf, khat and alcohol have been regularly used in different regions of the world in a variety of ways through the ages.
The apparent social acceptance of the use of such substances stemmed largely from the fact that there was no abuse.
Where there was, it was severely ostracized. Society had very clearly drawn the line and there was no question of
condoning any abuse.
Unfortunately, what we are witnessing today, on a global scale, is a virtual epidemic of drug abuse. According to United
Nations estimates, there are 15 million drug abusers (excluding cannabis) worldwide. This figure is considered to be a
conservative estimate or just the tip of the proverbial iceberg.
Adding a new and disturbing dimension to the problem is the fact that more and more young people are being affected
by what can only be described as the sinister network of global drug cartels. In view of the vulnerability of intravenous
drug users to AIDS, drug abuse has now assumed even more dangerous proportions.
What, however, needs to be borne in mind is that the various lawsand measures to prevent drug trafficking can succeed
only if there is genuine community involvement in stemming a tide that, if unchecked, could well engulf humanity. Given
the will and determination, countries of the world can work together to put an end to the death, destruction and violence,
the pain and the suffering that drug abuse has come to signify the world over.
WIIO/I 990/January /I
The material in this Information Kit is intended for media/public use and does not constitulean official document. Additional copies maybe obtained]
from: Public Information Unit, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, New Dclhi-110 002, India
DRUG DEPENDENCE - THE DEAD END
INFORMATION KIT
January 1991
Psychosocial Factors in Drug Dependence
uring adolescence, two determinants of behaviour appear which are important in the context of drug use: one is the
peers as role models in addition to the continuing role modelling by parents. The second is
take risks
challenge established rules and values. In combination, these two sets of determinants of
behaviour can lead to groups of adolescents taking risks or challenging established rules by a behaviour which none of
the group w'ould be likely to show alone, for example group violence, alcohol intoxication or initiation into taking of illicit
drugs.
increasing importance of
D
a tendency to
and to
PATHWAYS TO DRUGS
It has been convincingly argued that people take drugs because they are offered to them. It is very rare, at least for illicit
drugs, that first drug contacts happen on the initiative of the user. As a rule, careers of drug taking begin with an offer to
take the drug. This offer, when successful, normally happens in circumstances where it is difficult to turn the offer down,
in a situation which tends to be described - not very aptly - as social pressure or curiosity. More often it is in a situation
which could probably best be described as conducive to impetuous or precipitous behaviour: a mixture of peer modelling,
risk taking and challenging prescribed rules of behaviour. Or, “it will simply be an offer of the opportunity to join with
others in what appears to be a method of extending pleasurable aspects of a conventional recreational situation. So, in
spite of being ‘anti-drug’, he or she evaluates the offer not in terms of the drug education/morality tale (which is still
believed) but in terms of the current situation and the normal rules of behaviour (sociability, enjoyment, reciprocity,
keeping one’s cool, presenting self, etc.) appropriate in such recreational situations. This is true both for early offers of
legal drugs (cigarettes, alcohol) and for later offers of illegal drugs”.
Hardly any studies have been undertaken to elicit the circumstantial and emotional details of such situations of drug
initiation. It is difficult to see how programmes of ‘preventive education’ can be effective if so little is known about the
behaviour which is to be prevented. ‘Just say no’ is certainly not the full answer, especially when proposed by
representatives of the very norms and rules which the behaviour is challenging.
This lack of knowledge on the initiation into drugs has led to the generalization of the medical model of dependence
to drug use in general. We are asking for ‘causes’ of using drugs. There is evidence to suggest that dependence has a
certain medical connotation in that there exists a genetic predisposition towards it. However, the behaviour of taking a
drug or accepting the offer of a drug does seem to resemble a medical condition about as closely as do other behaviours
which imply a definite risk to health like skiing or mountaineering. All these behaviours are pleasurable. And in all of
them risk-taking is one component of the pleasure. The fact that people do things which they enjoy doing docs not seem
to need further explanation. However, it is important to keep in mind that risk-taking can be fun, and especially so during
adolescence. The physiological reactions to fear and fun are very similar. From observing only hormonal and some other
physiological changes we are normally not able to say whether a person is living through a frightening experience, is
enjoying a good joke or is experiencing an orgasm. The smooth and virtually timeless undulations between fright and fun
can well be observed on the faces of people on a roller-coaster. It is therefore not surprising that the probability of an
adolescent accepting the offer of a drug is not correlated to his knowledge about drugs. The component of pleasure
experienced in the process of drug initiation in many instances neutralizes the often unpleasant experience of the drug
effect itself. This excitement permits, for example, adolescents to become smokers inspite of the initial unpleasant bitterWHO/1990/January/2
. material in this Information Kit is intended for media/public use and does not constitute an official document. Additional copies may be obtained!
■n: Public Information Unit, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, New Delhi-110 002, India |
E
2
ness and cough provocation by cigarettes. They often have to literally ‘work’ themselves into regular use. Like skiers,
mountaineers or car drivers, drug users are convinced that they can control the risk. The facts, however, tell a different
story.
Whereas it is quite clear that in the beginning drugs are taken because they are offered, it is much less clear what makes
certain people to continue drug use and others to abandon it. A number of occasional users continue to be passive or
occasional users, i.e., they take drugs only if they arc offered or if otherwise available. This is true even of highly addictive
drugs like cigarettes and heroin. It is of course even more true of less addictive drugs like alcohol or cannabis.
Unfortunately, nothing seems to be known about the protective mechanisms which permit certain people to occasionally
use highly addictive substances without even proceeding to the state of active use, i.e., use where the drug is actively sought
and purchased. In contrast, some mechanisms have recently been described which permit regular users of heroin to
maintain control over its use without moving on to compulsive use (controlled use meaning regular use with effective
controls to make sure that the drug use does not substantially interfere with the user’s social and professional life,
compulsive use meaning that the drug use has taken such priority over other life concerns that it is continued in spite of
adverse consequences for the health or the professional or social life of the user). Such controlled use is of course much
easier to achieve with licit substances where unpredictable social (especially legal) sanctions are much less likely to occur,
and where therefore the likelihood of consequences affecting the social and professional life of the users are easier to
control. Furthermore, occasional users of highly criminalized drugs are much more likely to leave the mainstream of youth
and proceed into the ‘drug scene’ in a process of polarization between the established and a pro-drug-use counterculture,
thereby becoming drug dependents.
$
1 DRUG DEPENDENCE - THE DEAD END
INFORMATION KIT
January 1991
Community Involvement in Drug Abuse Control
ne may well ask what role communities could play in the control of drug abuse. Supply reduction is the job of the
Opolice. Demand reduction is the job of doctors in their treatment centres. To the extent that the police cannot stop
the availability of drugs, let the health service cure those who become drug addicts, in spite of all supply control efforts.
We have ample evidence from all over the world that these traditional strategies alone do not work. Law enforcement
will at times drastically reduce the availability of illicit drugs by spectacular seizures, or a vigilant narcotics police may
prevent the establishment of a criminal distribution network. But such successes do not seem to be sustainable. Clinics
to treat drug addicts may detoxify large numbers of them but the rates of relapse are high worldwide.
Could, then, people and communities achieve what agencies of law enforcement and health do not seem to be able to
achieve? The answer is neither yes nor no. The answer is: both agencies need people, communities, to be successful. And,
equally important, people, NGO’s and communities need Government support to be successful in their strive for a
drug-free environment.
Drug abuse, thereby, becomes closely linked to health care, with health services rendering necessary support. But for
successful prevention, and for caring for the disabled and chronically ill, community involvement is necessary. Only
people, friends, teachers, relatives, community leaders, peers, can prevent others from becoming drug dependent. And
only people, families, friends, employers, social workers, can help a drug dependent person to stay drug free.
A community-based study on pathways into drug dependence in Sri Lanka confirmed the appropriateness of a public
health model in its application to drug abuse: some people grow up in highly endemic areas, pockets in city slums where
anti-social activities, drug peddling and use of illicit drugs are "normal'1. Such people may socialize into drug use. But the
majority become individually infected by others. Drug abuse spreads from person to person. Drug peddlars befriend
before they offer the drug for the first time to their victims, free of charge of course for the first few times. How can we
immunize youth against becoming infected from a nice, healthy ‘friend’?
Awareness is certainly important. But it is not enough. An anti-drug attitude in the community and especially in youth
is certainly important. But it is also not enough. It is the social climate where drugs are not ‘in’ and where no pro-drug
subculture exists which protects youth, a social climate which only communities can generate through their young. The
full involvement of youth and their leaders will be able to increase resistance of youngsters against the befriending drug
peddlar. Some youngsters thus prepared will not only say ‘no’ to the offer of drugs but will be able to initiate action against
the peddlar or will help to rehabilitate a friend who has fallen victim to drugs.
A study group convened by WHO/SEARO in 1983 and 1984 reviewed the international experience regarding factors
which improve outcome in drug dependent persons. The conclusion was clear: whatever is done in terms of ‘treatment’
to the dependent person has little, if any, impact on long-term outcome. But the social environment in which the detoxified
ex-user lives largely determines the long-term outcome. A drug free environment, return into a family or another socially
supportive environment, long-term social support, return to school or work, existence of self-help groups of ex-users and
of affected families, factual knowledge about drugs and optimism in the family, are such factors. All show the need to
involve communities fully. How can community involvement be achieved?
WHO/1990/Jnnuary/3
The material in this Information Kit is intended for mcdia/public use and docs not constitute an official document. Additional copies maybe obtained!
from: Public Information Unit, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, New Delhi-110 002, India
2
There are some examples of effective community involvement in the South-East Asia Region. Asa preparation, people
in a locality are mobilized to take care of their drug problems, drug users identified and motivated to undergo
detoxification together, their parents and relatives are taught ways to handle drug problems including the skills of
detoxification (for opiates). A detoxification camp is then set up and ideally all drug dependent persons in the locality
detoxified together. Efforts are then made to transform them into self-help and perhaps vigilant groups to keep the locality
drug free. In this fully community-based approach most of the factors known to improve outcome in dependent persons,
but also those known to prevent drug abuse, are included. Such programmes now function in some parts of India,
Myanmar, and Sri Lanka. They often rely heavily on ex-users and other volunteers. The degree of professional involvement
varies in the different examples of this ‘camp approach towards drug free zones’. But it is clear that the scope for effective
community involvement of the above type requires a ‘community empowerment’ to solve their drug problems. It requires
professionals to be willing to hand over to the people as much of their skills as possible. Physicians, in their efforts towards
effective community involvement should be organizers, teachers, and perhaps outreach workers. Only then will health
services encourage and invite community involvement. And only then will drug abuse control programmes be able to
make major contributions to the reduction of demand for illicit drugs.
DRUG DEPENDENCE - THE DEAD END
INFORMATION KIT
January 1991
Fact Sheet and Glossary
DRUGS
Mind-altering drugs are used for purposes of intoxication throughout the animal kingdom. Normally, the seasonality in
the availability of intoxicating plants prevents animals from addiction. However, intoxicating plants being available for
long periods of time can lead to the extinction of certain species of animals or to their disappearance from a locality where
these plants grow throughout the year. Laboratory experiments have replicated the finding of a liking for intoxication and
an addiction-proneness in many animal species. Humans have early learned the skills of smoking intoxicating products
available continuously. Intoxication, and dependence, are known throughout recorded human history. Equally docu
mented are efforts to contain drug dependence by total abstinence/prohibition. Consistently, the efforts towards total
abstinence have failed in communities where drug use was well established, leading to a ‘tug-of-war between governments
and their people’.
DRUG USE AND DEPENDENCE
A major difficulty when discussing problems related to the use of mind-altering drugs lies in the definition of what may
be considered a problem. A government may wish that its citizens refrain from using any addictive substance (except,
normally, tobacco) and may therefore consider the occasional use of alcohol by some of its citizens as a problem. Other
governments may consider use of any mind-altering drug except the traditionally sanctioned substances alcohol and
tobacco as a problem. In some countries once-ever use of certain illicit substances is considered a problem whereas in
others only compulsive use of the same drug leading to social and/or health problems is seen as such (little difference
normally being made between problems related to the substance and those related more to its criminalization). WHO has
made efforts to clarify the issues involved by proposing a set of definitions concerning drug use in a WHO memorandum
issued in 1984. They are:
Unsanctioned use: use of a drug that is not approved by a society, or a group within that society. When the
term is used it should be made clear who is responsible for the disapproval. The term implies that we accept
disapproval as a fact in its own right, without having to determine or justify the basis of the disapproval.
Hazardous use: use of a drug that will probably lead to harmful consequences for the user - either to
dysfunction or to harm. This concept is similar to the idea of risky behaviour. For instance, smoking twenty
cigarettes each day may not be accompanied by any present or actual harm but we know it to be hazardous.
Dysfunctional use: use of a drug that is leading to impaired psychological or social functioning (e.g., loss of
job or marital problems).
Harmful use: use of a drug that is known to have caused tissue damage or mental illness in the particular
person.
In the same memorandum drug dependence is defined as a syndrome manifested by a behavioural pattern in which the
use of a given psychoactive drug, or class of drugs, is given a much higher priority than other behaviours that once had
WHO/L990/January/4
The material in this Information Kit is intended for media/public use and docs not constitutean official document. Additional copies maybe obtained
from: Public Information Unit, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, New Delhi-110 002. India
2
higher value. The term syndrome is taken to mean no more than a clustering of phenomena so that not all the components
need always be present, or not always present with the same intensity. They will probably include some of the following:
o a subjective awareness of compulsion to use a drug or drugs, usually during attempts to stop or moderate
drug use;
o a desire to stop drug use in the face of continued use;
o a relatively stereotyped drug-taking habit, i.e., a narrowing in the repertoire of drug-taking behaviour;
O evidence of neuroadaptation (tolerance and withdrawal symptoms);
o use of the drug to relieve or avoid withdrawal symptoms;
o the salience of drug-seeking behaviour relative to other important priorities;
o rapid reinstatement of the syndrome after a period of abstinence.
CANNABIS
The plant from which the various cannabis products are produced grows wild in many parts of the world and is easy to
cultivate. Cannabis products have been used for ceremonial and recreational purposes since times immemorial in many
parts of South-East Asia.
Cannabis is either smoked (e.g., charas) or ingested in food or as a concoction (e.g. bhang). It produces a sense of
relaxation and well-being. The addictive potential, i.e., the likelihood for users to become dependent on the drug is quite
low. But it is accused of being a ‘gate-way" drug to harder i.e. more addictive drugs. However, since no negative health
effects of the drug are known todate, some countries have decriminalized cannabis products in an effort towards
‘separation of markets’, i.e. to separate the markets and distribution networks for more dangerous drugs from the ones
for less dangerous drugs like cannabis products. A recent WHO publication has drawn the conclusion that "the
criminalization of drug use as currently applied should probably be seen as a punitive measure without noticeable
preventive effects. It may instead possess the potential to amplify the problem, particularly when applied in an
indiscriminate fashion to youngsters or to people who display no other forms of criminal or antisocial behaviour".
OPIOIDS
Drugs of this group may be synthesized, not chemically resembling the natural products or their derivatives. But at least
for the illicit market they largely derive from the cultivation of the poppy plant (opiates). The bulk of the international
illicit supply comes from countries of the ‘Golden Triangle’ (Myanmar, Laos, Thailand) and the ‘Golden Crescent’
(Afghanistan, Pakistan, Iran). The preparations most frequently used are opium (smoked or ingested as concoction) and
the about 10 times more effective distillation product heroin (inhaled, smoked or injected). Medicinal preparations used
as substitutes by drug dependents are mainly codeine (in many cough syrups) and morphine in its various medicinal
preparations and equivalents.
Opium, like cannabis, has been used since times immemorial in many South-East Asian countries or communities. In
contrast to cannabis products, opium dependence has also been recognized as a problem in those communities, especially
where poppy was not grown locally, generating an economic dependence on outside suppliers.
Heroin, the ten-fold more powerful and addictive derivative of opium, entered the market in several countries of
South-East Asia shortly after opium use was prohibited. There is good reason to suggest that the criminalization of
established networks of distribution of a traditional drug was conducive to the propagation of the more profitable heroin
(being more addictive and therefore generating more reliable buyers).
The opioids produce a state of relaxation and a feeling of happiness. The latter may be a shortlived feeling of bliss or
ecstasy. But many opiate dependent persons continue taking the drugs for simply avoiding withdrawal symptoms (cramps
pains, tears, sweating, diarrhoea, and the like. But all of these symptoms arc highly amenable to environmental and social
manipulation).
OTHER DRUGS
In many countries of the South-East Asian Region the use of alcohol poses a much higher public health
11
any of the illicit drugs. This is probably true of tobacco also. Other illicit drugs like cocaine and amphet P™
thaH
expensive relative to opioids and cannabis to pose public health threats to the Region.
‘ P atnlnes are 100
Licit drugs like benzodiazepines and barbiturates are sometimes substituted by opiate users in the R '
seem to pose a serious problem as drugs of primary dependence.
eg>on, but do not
DRUG DEPENDENCE - THE DEAD END
INFORMATION KIT
January 1991
Drug Abuse in South-East Asia : An Overview
HISTORICAL BACKGROUND
Since times immemorial, in most of the countries of the South-East Asia Region drugs have traditionally been used, in
addition to alcohol, for ritual, religious, and recreational purposes. These drugs are mainly cannabis products and opium.
Even though opium dependence was usually ostracized in most communities, it was rarely considered as being more than
an individual problem. Many countries permitted the requirements of the opium dependent population to be met through
official or officially tolerated opium outlets.
However, ‘wars on drugs’ were also sometimes fought, as, for example, the civil war in Thailand following an opium
ban in 1811. Finally, the opium franchise was enacted in 1851 permitting opium trading under official control.
The increase in drug abuse in the West led to increasing pressure, often from abroad, on countries in the Region to
introduce and enforce a ban on drugs.
The ban on opium in Thailand in 1959 was followed almost immediately by the first heroin epidemic in the country.
ISSUES IN THE EPIDEMIOLOGY OF DRUG DEPENDENCE
Drug use is transmitted from person to person like an infectious disease. In addition, there is also a disease vector, viz.,
the drug dealers, often themselves drug dependent. Rates of cure through treatment in medical terms are low.
Knowledge about the dangers of drugs has well been established to lack the protective quality of a vaccine.
Furthermore, the process of becoming drug dependent has a high predictive value for outcome: people who become
dependent through aggressive marketing have a much better chance of recovery than those who became dependent in
the process of pleasure seeking. And persons who have become opiate dependent through treatment of chronic severe
pain tend to have the normal withdrawal symptoms but do not normally experience craving afterwards.
DRUG DEPENDENCE IN THE SOUTH-EAST ASIA REGION
In most countries of the Region, nicotine and alcohol dependence with its well established health consequences are the
major public health concerns. However, in view of the special economic, social, and security considerations in relation
to illicit drugs, we shall limit ourselves to the use of cannabis and opioids.
Virtually no data exists on the use of cannabis in the South-East Asia Region. In view of the fact that the plant grows
wild and abundantly in many parts of the Region, and that the use of cannabis products is traditional in some and probably
of little public health concern in almost all, the lack of such data seems justifiable.
WHO/1990/January /S
The material in this Information Kit is intended for media/public use and does not constitute an official document. Additional copies may be obtained
from: Public Information Unit, World Health Organization, Regional Office for South-East Asia, Indrapraslha Estate, New Delhi-110 002, India
2
The only other widely abused illicit drugs are opiates. Again, reliable data on the extent of the problem are scarce.
Furthermore, existing survey data tend to lack a denominator, i.e. they cannot be translated into national or other
population estimates.
For example, a national drug dependence registry in Myanmar now contains some 44 000 cases. However, in the
absence of validatory community surveys, no extrapolation can be made to the general prevalence of drug dependence.
Furthermore, the register is cumulative since 1974 with no mechanism for deregistration. Nor is there a mechanism for
an effective control of multiple registrations.
In Thailand, 80 000 opium smokers were registered in 1958, before the ban. Since then, treatment data are being
registered and eventually linked and analysed on a regular basis. However, these data are rarely validated in relation to
their meaning for populations or communities. The magnitude of the problem can be guessed from the fact that over
30 000 opiate dependents are treated every year.
Unfortunately, it is impossible to estimate with any precision the population prevalence of opioid dependence from
treatment data although it is known from community surveys in Sri Lanka and Thailand that at least 60% of actual active
opioid dependents have been treated at some stage. This is so because the rate of treatments per year of active drug use
is not known. Estimates of actual opioid dependents in Thailand vary roughly between 150 000 and 300 000.
For the other affected countries like Bangladesh, India, Nepal, and Sri Lanka, only vague overall estimates are
available, the basis of which are not clear in most instances. For India an estimate of several hundred thousand heroin
dependents has recently been put forward in a UN project document. For the South of Sri Lanka and for Nepal, official
estimates put forward are in the order of 25 000-35 000. Such estimates may derive from a multiplication of treatment or
prison data by some “UN factor’. Such multipliers (e.g. one out of ten dependent persons comes for treatment per year)
generally lack international and even more so national or local validation. It is quite clear, often, that such estimates are
put forward for reasons of anti-drug advocacy rather than for reasons of facilitating epidemiology-based interventions.
introduction
The WHO Expert Committee on the Use of Essential Drugs met in
Geneva horn 15 to 19 November 1993. The meeting was opened on
behalf of the Director-General by Dr F.S. Antezana. Assistant DirectorGeneral. who emphasized that the concept of essential diiius was
fundamental both to WHO's revised drug strategy (/). as endorsed by the
World Health Assembly in resolution WHA39.27 in I9S6 (2). and to the
development of comprehensive national drug policies. Regular updating
of WHO's Model List of Essential Drugs sustained the momentum of the
revised drug strategy and was a basic element of the validated informa
tion required by most of WHO's Member States for optimal rationali
zation of drug procurement and supply.
The Expert Committee decided to prepare its report as a self-contained
document and to incorporate into it those parts of the previous report (3)
that required no modification or merely bringing up to date. The eighth
Model List of Essential Drugs will be found in section 16 of this report.
and explanations ol Hie changes in section 17. The Committee agreed to
annex to its report the report of a WHO consultation on the provision and
dissemination of drug information (Annex 1). together with guidelines
prepared by various WHO consultations on antimicrobial susceptibility
testing (Annex 2) and on good clinical practice for trials on pharmaceutical
products (Annex 3) in order to bring them to the attention of those in
charge of national drug policies.
In a report (7) to the Twenty-eighth World Health Assembly in 1975. the
Director-General reviewed the main drug problems facing the developing
Countries and outlined possible new drug policies. The Director-General
also referred to the experience gained in some countries where schemes
of basic or essential dings hail been implemented. Such schemes were
intended to extend the accessibility anil rational use of the most
necessarv drugs to populations whose basic health needs could not be
met bv the existing supply system. The Director-General pointed out that
the selection of these essential drugs would depend on the health needs
and on the structure and development of the health services of each
countrv. Lists ol' essential drugs should be drawn up locally and
p.riodicallv updated, with the advice ol experts in public health.
medicine, pharmacology, pharmacy and drug management. He also
considered that adequate information on the properties, indications and
use of the drugs listed should be provided. By resolution WHA28.66 (5).
the Health Assemblv requested the Director-General to'implement the
proposals contained in his report and. in particular, to advise Member
States on the selection and procurement, at reasonable cost, ol essential
dines of established quality corresponding to their national health needs.
following wide consultation. an initial Model List of Essential Drugs
v .is included in the first report of the Expert Committee on the Selection
of Essential Drugs (6). This has subsequently been revised and updated
in six further reports i.’. 7-11).
1
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Fc«!
, a £
*. i 4
Mei,;
■
I C\ Ct
2
In undertaking a further review of the list at its present meeting, the
Expert Committee was guided throughout by the following statement
contained in the previous reports:
Because of the great differences betw een countries, the preparation of
a drug list of uniform, general applicability is not feasible or possible.
Therefore, each country has the direct responsibility of evaluating and
adopting a list of essential drugs, according to its own policy in the
field of health.
The list of essential drugs based on the guidelines pul forward in this
report is a model which can furnish a basis tor countries to identify
their own priorities .mil to make their own selection.
The Committee also drew attention to the following guidelines set out in
the initial report:
I.
The extent to which countries implement schemes or establish lists of
essential drugs is a national policy decision of each country.
2.
As far as health services in developing countries are concerned, the
organized procurement and use of essential drugs have many
advantages in terms of economy and effectiveness. However, the
concept of "essential drug lists" must accommodate a variety of local
situations if the lists are ever to meet the real health needs of the
majority of the population.
3.
There are convincing justifications for WHO to propose "model" or
"guiding" lists of essential drugs as a contribution to solving the
problems of Member States whose health needs far exceed their
resources and who may find it difficult to initiate such an endeavour
on their own.
4.
Such "guiding" or 'model" lists should be understood as a tentative
identification of a "common core" of basic needs w hich has universal
relevance and applicability. In certain situations, there is a need to
make available additional drugs essential for rare diseases. The further
local needs move aw ay from the core, the more the health authorities
or specific sectors of the health services w ill have to adjust the lists.
However, any list proposed by WHO should set out to indicate
priorities in drug needs, with the full understanding that exclusion
does not imply rejection. A list of essential drugs does not imply that
no other drugs are useful, but simply that in a given situation these
drugs are the most needed for the health care of the majority of the
population and. therefore, should be available at all times in adequate
amounts and in the proper dosage forms.
5.
The selection of essential drugs is a continuing process, which should
take into account changing priorities for public health action and
epidemiological conditions, as well as progress in pharmacological g
and pharmaceutical knowledge. It should be accompanied by 3
concomitant effort to supply information and give education and £
trainitm to health personnel in the proper use of the drugs.
Einally. the WHO Action Programme on Essential Drugs should be
a local point for organized and systematic investigation of this
approach. Thus it will identify plans of action and research at the
national and international level to meet unsatisfied basic health needs
of populations which, at present, tire denied access to the most
— essential prophylactic and therapeutic substances.
6.
2
Guidelines for establishing a national
programme for essential drugs
Since the first report on the selection of essential drugs w as published in
I97-. the concept of essential drugs has been widely applied. It has
provided a rational basis not only for drug procurement al national level
but also for establishing drug requirements at various levels within the
health care system. In fact, many developing countries have already
selected essential drugs according to their needs and the related
programmes arc. in some cases, at an advanced stage of implementation.
The Committee was informed that a WHO Expert Committee on
National Drug Policies would be convened in 1994 to review the
guidelines for developing national drug policies t/2).
In order to ensure that an essential drugs programme is adequately
instituted at national level, several steps are recommended:
1 ■ A standing committee of health care professionals should be
appointed to give technical advice to the national programme. The
committee should include individuals competent in the fields of
medicine, pharmacology and pharmacy, as well as peripheral health
workers. Where individuals with adequate training are not available
w ithin the country , cooperation from WHO could be sought until such
indiv iduals can be trained. The first task of the committee should be to
recommend a list of essential drugs for the national programme. The
committee should remain a part of the national programme for
essential drugs, continually advising on matters of technical impor
tance.
- The international nonproprietary (generic) names for drugs or phar
maceutical substances (13) should be used whenever available, and
prescribers should be provided with a cross-index of nonproprietary
and proprietary names.
Concise, accurate and comprehensive drug information should be
prepared to accompany the list of essential drugs, in the form of a
prescriber's formulary to serve as a pocket guide to rational drug use.
More detailed information about drugs should be made available at
drug and poison information centres, pharmacies and all educational
institutes concerned with training health professionals.
Quality, including drug content, stability and bioavailability, should
be assured through testing or regulation, as discssed in section 5.
M here national resources are not available for this type .‘’control, the
suppliers should provide documentation of the products compliant
with the required specifications.
5. Competent health authorities should decide the level of expertise
required to prescribe individual drugs or a group of drugs in a
therapeutic category. Consideration should be given, in particular, to
the competence of the personnel to make a correct diagnosis. In some
instances, while individuals with advanced training are necessary t0
prescribe initial therapy. individuals with less training could be
responsible for maintenance therapy.
6. The success of the entire essential drugs programme is dependent
upon the efficient administration of supply, storage and distribution at
every point from the manufacturer to the end-user. Government
intervention may be necessary to ensure the availability of some dru«,
in the formulations listed, and special arrangements may need to be
instituted for the storage and distribution of drugs that have a short
shelf-life or require refrigeration.
7.
Efficient management of stocks is necessary to eliminate waste and to
ensure continuity of supplies. Procurement policy should be ba-ed
upon detailed records of turnover. In some instances, drug utilization
studies may contribute to a better understanding of true requirements.
S. Research, both clinical and pharmaceutical, is sometimes required to
settle the choice of a particular drug product under local conditions.
Facilities and trained personnel for such research must be provided.
Clinical trials on pharmaceutical products should follow the Guide
lines for Good Clinical Practice (GCP) for Trials on Pharmaceutical
Products included as Annex 3.
9. A national drug regulatory authority should be established along the
lines recommended in the guiding principles for small national drug
regulator) authorities presented in Annex 1 of the Committee'- prev ions report (3). The authority should interact with other interested bod
ies. including organizations responsible for drug procurement in the
public and private sectors and the committee referred to in item 1.
3
Criteria for the selection of essential drugs
Essential drugs are those that satisfy the health care needs of the majority
of the population: they should therefore be available al all limes in
adequate amounts and in the appropriate dosage forms.
The choice of such drugs depends on many factors, such as the pattern ol
prevalent diseases: the treatment facilities: the training and experience
of the available personnel: the financial resources: and genetic.
demographic and environmental factors.
Because of differing view son the definition of an essential drug in terms
of what is meant by the "health care needs of the majority" of the
population, the model list has been gradually expanded since its
introduction. Some drug- tire included that are essential only if ;1
therapeutic programme is planned to address the diseases for which these
drugs are used. For example, the cytotoxic drugs (section 8.2 of the
model list) are essential only if a comprehensive cancer treatment
programme is planned. Such a programme requires adequate hospital.
diagnostic and clinical laboratory facilities for its implementation. In
contrast, the drugs used in palliative care (section 8.4) are always
essential, even when a comprehensive cancer treatment programme does
not exist.
Only those drugs should be selected for which sound and adequate data
on efficacy and safety are available from clinical studies and for which
evidence of performance in general use in a variety of medical settings
has been obtained.
Each selected drug must be available in a form in which adequate quality.
including bioavailability, can be assured: its stability under the anticipated
conditions of storage and use must be established.
Where two or more drugs appear to be similar in the above respects, the
choice between them should be made on the basis of a careful evaluation
of their relative efficacy, safety, quality. price and availability.
In cost comparisons between drugs, the cost of the total treatment, and
not only the unit cost of the drug, must be considered. The cost/benefit
ratio is a major consideration in the choice of some drugs for the list. In
some cases the choice may also be influenced by other factors, such as
comparative pharmacokinetic properties, or by local considerations such
as the ax ailabilily of facilities for manufacture or storage.
XI.'si essential drugs should be formulated as single compounds. Fixedratio combination product' are acceptable onlx when the dosage of each
ingredient meets the requirements of a defined population group and
when the combination has a proven advantage over single compounds
administered separate!) in therapeutic effect, safely or compliance.
Guidelines for the selection of
pharmaceutical dosage forms
The purpose of selecting dosage forms and strengths for the drugs in the
model list is io provide guidance to countries wishing to standardize or
minimize the number of preparations in their own drug lists. As a general
rule, pharmaceutical forms are selected on the basis of their general
utility and their wide availability internationally. In many instances, a
choice of preparations is provided, particularly in relation to solid dosage
forms. Tablets are usually less expensive than capsules, but. while cost
should be taken into account, the selection should also be based on a
consideration of pharmacokinetics, bioavailability, stability under ambient
climatic conditions, availability of excipients, ami established local
preference.
In a few instances where there is no uniformity of tablet strength. fOr
example acetylsalicylic acid and paracetamol, a dosage range is prot ided
from within which suitable tablet strengths should be selected on the
basis of local availability and need. When precise dosage is not
mandatory, the use of scored tablets is recommended as a simple method
of making dosage more flexible if so required and. in some instances. t0
provide a convenient paediatric dose. Specific paediatric dosages and
formulations are included in the list only when indicated by special
circumstances. In many instances, dosage is specified in terms of a
selected salt or ester, but in others - for example chloroquine - it j5
calculated, in accordance with common practice, in terms of the active
moiety.
For certain drugs with short half-lives that are rapidly metabolized.
such as carbamazepine, calcium-channel blockers and theophylline.
conventional-release dosage forms must often be taken three or four
times a day to maintain drug levels in the required narrow range.
Sustained-release dosage forms can reduce the frequency of drug
administration, thereby improving compliance and. often, the therapeutic
effectiveness of the drug by maintaining a more constant drug level than
can be obtained using traditional dosage forms. Because the preparation
of sustained-release products is difficult and requires special expertise, a
proposal to include such a product in a national list of essential drugs
should be justified by adequate documentation.
5.
Quality assurance
Quality assurance of drug', as embodied in product development, good
manufacturing practice and subsequent monitoring of quality throughout
the distribution chain to utilization, is a crucial element in any e"er.tial
drugs programme. All aspects of these procedures hav e been dealt w ith at
length in the twenty-sixth to thirty-third reports of the WHO Expert
Committee on Specifications for Pharmaceutical Preparations (!4-2h.
Priority should be given to ensuring that die available drugs have been
made according to good manufacturing practices (20. Annex I; and are
of generally recognized quality. This requires knowledge of and confidence
in the origin of the product. The risks of procuring drugs from anony ntous
sources cannot be overstressed. It is recommended that drugs are purchased
directly from known manufacturers, their duly accredited agent' or
recognized international agencies known to apply high standards in
selecting their suppliers.
The Committee emphasized the importance of WHO'' Certification
Scheme on the Quality of Pharmaceutical Products Moving in International
Commerce, particularly in countries with inadequate laboratory facilities
lor drug analy si' which may be unable to carry out the process of quality
control. This scheme ha' been available since 1975 as a meath ot
exchanging information between regulatory authorities in importing and
exporting countries. Its purposes are:
To provide assurance that a given product has been authorized to be
I.
placed on the market in the exporting country, and. if not. to explain
why authorization has been withheld.
To provide assurance that the plant in which the product is manufactured
2.
is subject to inspections at suitable intervals and conforms to the
requirements
for
good
practices
in
and
manufacture
the
quality
control of drugs, as recommended by WHO.
To provide for exchange of information on the implementation of
3.
inspections and controls by the authorities in the exporting country.
In the case of serious quality defects inquiries may also be made.
In
1988
the
accordance
scope
'of
World
with
scheme
certification
the
Health
Assembly
extended,
in
WHA4I.I8.
to
was
resolution
provide for a more comprehensive exchange of information between
governments (22 >.
were,
Drug substances as well as finished dosage forms
within
included
and
scheme
the
was
provision
for
made
the
exchange of officially approved, product-specific prescribing information
on the safety and efficacy of finished products.
The
Committee
to
wishes
national
encourage
authorities
to
issue
certificates in precise conformity w ith the format proposed by WHO in
order to ensure that clear details are given about a product's place of
manufacture
or
assembly
whether
and
manufacturing
practice
have
alreadx
done
so
are
urged
manufacturers
of
pharmaceutical
to
WHO's
applied.
been
extend
the
products
of
standards
Countries
system
that
of
destined
good
have
not
licensing
to
exclusively
for
export. The licensing system should ensure that these manufacturers are
vjbiect to inspection, that they
requirements
for
good
comply
with internationally
manufacturing
practices,
and
recognized
every
that
reasonable precaution is taken to ensure that the quality of their products
meets pharmacopoeia! specifications.
Poor bioaxailability of a pharmaceutical product can result in treatment
failure just as readily
as can a deficiency
of active ingredients in the
product. The bioaxailability of essential drugs should therefore continue
to rcceixe consideration since it is a key factor in quality assurance.
The Committee appreciates that the development of the Model List of
essential Drug' has proxided a natural focus for the third edition of The
ii::i nuilii’iial i>huriiiciei'i’<ieiii (2.>). thus enhancing its potential
to dexeloping countries. Essential drugs are accorded priority
value
and all
qualitx specifications are supported by classical methods of testing and
analxsis. A plan for a small quality -control laboratory'in which most of
these tests can be performed has been available since 1984 t/7). Since
qualitx
assurance
of essential
drugs
is so important,
the
Committee
recommends to national goxernments the setting up of such laboratories
and the adoption of The iiiieinaiioiuil pharimuopneiu by those currently
lacking the means to confirm independently the quality of the supplies
thex
procure.
Where
national
inxolxing several countries max
capacity
is
lacking,
a
regional
effort
be useful. In this context, attention is
also drawn to the Wl’lO publication liasic ic>!\ lor pliannaceutical
substances (24). which enables the identity of drug substance'- to be
verified ami gross degradation to be excluded when laboratory facilities
for full pharmacopoeia! analyses are not available.
the need to extend the coverage ol The
international pharmacopoeia to include not only essential drug substances.
The Committee emphasizes
but also the dosage forms (25) specified in the Model List of Essential
Drugs, together with additional information on bioaxailability. stability
and recommended packaging anil storage conditions.
6.
Reserve anti-infective agents and monitoring
of resistance
The increasing prevalence of strains of common
pathogenic bacteria
resistant to widely available, relatively cheap antimicrobials included in
the model list is. in many cases, dangerously eroding their effectiveness.
The neeojor more systematic ami coordinated international approaches
to laboratory monitoring of antimicrobial
sensitivity
is
important and
urgent. It has already been emphasized that reference laboratories need to
be established'in developing as well as developed countries in order to
monitor the resistance of important bacterial pathogens (26. 27). Each
Member country should have a national reference laboratory to monitor
the local resistance patterns of important microorganisms. Know ledge ot
prevailing sensitivity
patterns is vital to the proper selection and use
of antimicrobials and
the development of appropriate
to
prescribing
policies. Without these data the health of seriously ill patients could be
jeopardized. Knowledge of sensitivity patterns should come from proper
laboratory investigations. Hovvever. in countries with inadequate facilities
for monitoring
resistance,
clinical evidence of lack of efficacy
ot a
particular antimicrobial against a particular infectious disease should be
utilized to modify
the drug treatment for the particular disease in the
\
community concerned.
It is becoming increasingly common for important pathogens to emerge
in a country or locality
that are shown, on sensitivity
testing, to have
developed resistance to all normally appropriate essential dings. In these
circumstances a reserve antimicrobial is needed. A reserve antimicrobial
is an antimicrobial that is useful
for a wide range of infections but.
because of the need to reduce the risk of development of resistance and
because of its relatively high cost, it would be inappropriate to recommend
its unrestricted use.
\
The concept of reserve antimicrobials is of practical relevance only w hen
information
is
available
on
the
prevailing sensitivities
of important
bacterial pathogens. Within this context the second-'and third-generatio11
cefalosporins. the fluoroquinolones and vancomycin tire most importaiii-
I
Volume 13, Number 4, 1999
World Health Organization, Geneva
WHO Drug information
Contents
Regulatory and Safety Matters
General Policy Issues
Access to essential drugs
217
WHO's role in ensuring access to essential
drugs
217
Access to medicines: an urgent need for
solutions
220
Amsterdam statement on access to medicines 223
Reports on Individual Drugs
Influenza preparedness plan: antiviral drugs
Atovaquone and proquaml hydrochloride:
a new antimalarial combination
225
226
Current Topics
Roll Back Malaria
The Medicines for Malaria Venture (MMV)
The Japanese alliance
A new antimalarial donation programme
Roll Back Malaria in Europe
The WHO Antimicrobial Resistance
Information Bank
228
228
228
229
229
230
Vaccines and Biomedicines
Quality assurance and safety of
biologicals
Influenza preparedness plan: vaccine
production and availability
Thiomersal: theoretical risk leads to
phasing out
Leflunomide: pancytopenia and skin reactions
Didanosine and pancreatitis
Sertraline for post-traumatic stress disorder
Pemoline withdrawal following liver
complications
Levetiracetam: new drug for epilepsy
Methotrexate: monitoring essential
Methotrexate: care in prescribing
Grepafloxacin withdrawal: severe
cardiovascular events
Reteplase incompatible with heparin
Postmarketing system to be revised
Abacavir: hypersensitivity reactions
Initiative to curb illegal sale of drugs over
the Internet
Unapproved HIV test kits available on
the Internet
V-King®: unapproved use of sildenafil
Miralex®: undeclared corticosteroid
Rules for dietary supplements finalized
238
238
238
238
239
239
239
239
239
240
240
240
240
241
241
241
ATC/DDD Classification
Temporary list
242
Final list
245
Essential Drugs
231
235
237
WHO Model List (revised December 1999)
249
Proposed International
Nonproprietary Names: List 82 263
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
WHO Mode! List (revised December 1999)
injection for spinal anaesthesia,
0.5% (hydrochloride) in 4-ml ampoule
to be mixed with 7.5% glucose solution
Section 1: Anaesthetics
1.1
GENERAL ANAESTHETICS AND OXYGEN
ether, anaesthetic (1c) (2)
inhalation
halothane (2)
inhalation
ketamine (2)
injection, 50 mg (as hydrochloride)/ml in 10-ml vial
nitrous oxide (2)
“thiopental (2)
injection for spinal anaesthesia.
5% (hydrochloride) in 2-ml ampoule
to be mixed with 7.5% glucose solution
inhalation
topical forms, 2-4% (hydrochlonde)
powder for injection, 0.5 g. 1.0 g
(sodium salt) in ampoule
LOCAL ANAESTHETICS
“bupivacame (2. 9)
injection. 0.25%. 0.5%
(hydrochloride) in vial
injection, 1%, 2%
(hydrochloride) in vial
injection, 1%, 2% (hydrochloride)
+ epinephnne 1:200 000 in vial
inhalation (medicinal gas)
oxygen
1.2
“lidocaine
dental cartridge. 2% (hydrochloride)
+ epinephrine 1:80 000
Complementary drug
ephedrine (C)
injection. 30 mg
(For use in spinal anaesthesia
(hydrochlonde)/ml in
dunng delivery to prevent hypotension)
1 -ml ampoule
° Example of a therapeutic group. Various drugs can serve as alternatives.
Explanatory Notes
When lhe strength of a drug is specified in terms of a
selected salt or ester, this is mentioned in brackets: wnen it
refers to the active moiety, the name of the salt or ester in
brackets is preceded by lhe word ’as'.
Many drugs included in the list are preceded by a box t°) to
indicate that they represent an example of a therapeutic
group and that various drugs could serve as alternatives. It
is imperative that this is understood when drugs are selected
at national level, since choice is then influenced bv the
comparative cost and availability of equivalent products.
Examples of acceptable substitutions include:
° Hydrochlorothiazide: any other thiazide-type diureoc cur
rently in broad clinical use.
“ Hydralazine: any other penpheral vasodilator having an
antihypertensive effect.
“ Senna: any stimulant laxative (either synthetic or of plant
origin).
° Sulfadiazine: any other short-acting, systemically active
sulfonamide unlikely to cause crystalluria.
United Nations Convention against Illicit Traffic in Narcotic
Drugs and Psychotropic Substances (1988).
(2)
Specific expertise, diagnostic precision, individualization
of dosage or special equipment required for proper use.
(3)
Greater potency or efficacy.
(4)
In renal insufficiency, contraindicated or dosage adjust
ments necessary.
(5)
To improve compliance.
(6)
Special pharmacokinetic properties.
(7)
Adverse effects dimmish benefit/risk ratio.
(8)
Limited indications or narrow spectrum of activity.
(9)
For epidural anaesthesia.
(10)
Sustained-release preparations are available. A pro
posal to include such a product in a national list of essential
drugs should be supported by adequate documentation.
(11)
Monitonng of therapeutic concentrations in plasma can
improve safety and efficacy.
Letters in parentheses following the drug names indicate the
reasons for the inclusion of complementary drugs:
(A)
When drugs in the main list cannot be made available.
(B)
When drugs in the main list are known to be ineffective or
inappropriate for a given individual.
Numbers in parentheses following drug names indicate:
(C)
For use in rare disorders or in exceptional circumstances.
(1)
Drugs subject to international control under (a) the (D)
Reserve antimicrobials to be used only when there is
Single Convention on Narcotic Drugs (1961); (b) the Con
significant resistance to other drugs on the list.
vention on Psychotropic Substances (1971); or (c) the
Drugs are listed in alphabetical order.
249
1
Essential Drugs
1.3
WHO Drug Information Vol. 13, No. 4, 1999
DISEASE-MODIFYING AGENTS USED
PREOPERATIVE MEDICATION & SEDATION 2.4
IN RHEUMATIC DISORDERS
FOR SHORT-TERM PROCEDURES
injection, 1 mg (sulfate)
in 1-ml ampoule
atropine
chloral hydrate
syrup, 200 mg/5 ml
“diazepam (1b)
injection, 5 mg/ml
in 2-ml ampoule
azathioprine (2)
tablet, 50 mg
chloroquine (2)
tablet, 100 mg, 150 mg
(as phosphate or sulfate)
tablet, 25 mg
cyclophosphamide (2)
tablet, 5 mg
methotrexate (2)
tablet. 2.5 mg (as sodium salt)
“morphine (1a)
injection, 10 mg (sulfate or
hydrochloride) in 1-ml ampoule
penicillamine (2)
capsule or tablet, 250 mg
sulfasalazine (2)
tablet. 500 mg
“promethazine
elixir or syrup, 5 mg
(hydrochloride)/5 mt
Section 2: Analgesics, Antipyretics,
Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs), Drugs Used to
Treat Gout and Disease-Modifying
Agents used in Rheumatic
Disorders (DMARDs)
2.1 NON-OPIOID ANALGESICS & NSAIDs
acetylsalicylic acid
Section 3: Antiallergics and
Drugs Used in Anaphylaxis
tablet, 4 mg (hydrogen maleate)
“chlorphenamine
injection. 10 mg (hydrogen
maleate) in 1-ml ampoule
tablet. 500 pg. 4 mg
“dexamethasone
injection, 4 mg
dexamethasone phosphate
(as disodium salt) in 1-ml ampoule
epinephnne
injection. 1 mg (as hydro
chlonde or hydrogen tartrate)
in 1-ml ampoule
hydrocortisone
powder tor injection, 100 mg
(as sodium succinate) in vial
“prednisolone
tablet, 5 mg
tablet. 100-500 mg
suppository, 50-150 mg
“ibuprofen
tablet. 200 mg, 400 mg
paracetamol
tablet. 100-500 mg
suppository, 100 mg
syrup. 125 mg/5 ml
2.2
OPIOID ANALGESICS
tablet. 30 mg (phosphate)
“codeine (1a)
“morphine (1a)
injection. 10 mg (sulfate or
hydrochlonde) in 1-ml ampoule
oral solution, 10 mg (hydrochloride
or sulfate))/5 ml
tablet. 10 mg (sulfate)
4.1
NON-SPECIFIC
“charcoal, activated
ipecacuanha
injection. 50 mg
(hydrochloride) in 1-ml ampoule
4.2 SPECIFIC
atropine
tablet, 50 mg, 100 mg (hydrochloride)
2.3
DRUGS USED TO TREAT GOUT
allopurinol (4)
tablet, 100 mg
colchicine (7)
tablet, 500 pg
calcium gluconate (2, 8)
deferoxamine
“ Example of a therapeutic group. Various drugs can serve as alternatives.
250
powder
syrup, containing 0.14% ipecacuanha
alkaloids calculated as emetine
acetylcysteine
Complementary drug
“pethidine (A) (1a, 4)
Section 4: Antidotes and Other
Substances Used in Poisonings
injection, 200 mg/ml
in 10-ml vial
injection, 1 mg (sulfate)
in 1-ml ampoule
injection. 100 mg/ml
in 10-ml ampoule
powder for injection, 500 mg
(mesilate) in vial
Essential Drugs
WHO Drug Information Vol. 13. No. 4, 1999
dimercaprol (2)
injection in oil. 50 mg/ml
in 2-ml ampoule
“□i-methionine
tablet, 250 mg
injection, 10 mg/ml
in 10-ml ampoule
methylthioninium chloride
(methylene blue)
injection, 400 pg (hydrochloride)
in 1-ml ampoule
naloxone
capsule or tablet, 250 mg
penicillamine (2)
potassium ferric hexacyanoferrate(ll) -2H2O (Prussian blue)
sodium calcium edetate (2)
powder for oral
administration
injection, 200 mg/ml
in 5-ml ampoule
sodium nitrite
injection, 30 mg/ml
in 10-ml ampoule
sodium thiosulfate
injection. 250 mg/ml
in 50-ml ampoule
Section 6: Anti-infective Drugs
6.1
ANTHELMINTHICS
INTESTINAL ANTHELMINTHICS
6.1.1
albendazole
chewable tablet. 400 mg
levamisole
tablet, 50 mg, 150 mg
(as hydrochloride)
’mebendazole
chewable tablet, 100 mg, 500 mg
chewable tablet, 500 mg
niclosamide
praziquantel
tablet, 150 mg, 600 mg
pyrantel
chewable tablet. 250 mg
(as embonate)
oral suspension, 50 mg
(as embonate)/ml
ANTIFILARIALS
6.1.2
tablet. 50 mg, 100 mg
(dihydrogen citrate)
diethylcarbamazme
Section 5: Anticonvulsants/
Antiepileptics
ivermectin
carbamazepine (10, 11) scored tablet. 100 mg, 200 mg
suramin sodium (8) (2. 7)
’diazepam (1b)
an
injection, 5 mg/ml in 2-ml
>ule (intravenous or rectal)
6.1.3
capsule. 250 mg
ethosuximide
magnesium sulfate
scored tablet. 3 mg. 6 mg
Complementary drug
powder for injection.
1 g in vial
ANTISCHISTOSOMALS AND OTHER
ANTITREMATODE DRUGS
syrup, 250 mg/5 ml
praziquantel
tablet. 600 mg
injection. 500 mg/ml
m 2-ml ampoule
and 10-ml ampoule
triclabendazole
tablet. 250 mg
Complementary drug
capsule. 250 mg
oxamniquine (C) (8)
tablet. 15-100 mg
phenobarbital (lb. 11)
syrup. 250 mg/5 ml
elixir. 15 mg/5 ml
phenytoin (7. 11)
25 mg.
capsule or tablet.
mg, 100 mg (sodium salt)
injection. 50 mg
(sodium salt)/ml in 5-ml vial
valproic acid (7. 11)
BETA LACTAM DRUGS
“amoxicillin
capsule or tablet. 250 mg.
500 mg (anhydrous)
powder for oral suspension.
125 mg (anhydrous)/5 ml
enteric coated tablet.
200 mg, 500 mg (sodium salt)
Complementary drug
’clonazepam (8) (1b)
6.2 ANTIBACTERIALS
6.2.1
ampicillin
powder for injection, 500 mg.
1 g (as sodium salt) in vial
benzathine
benzylpenicillin
powder for injection.
1.44 g benzylpenicillin
(= 2.4 million IU) in 5-ml viai
benzylpenicillin
powder for injection.
600 mg (= 1 million IU).
3 g (= 5 million IU)
(sodium or potassium salt) in vial
scored tablet. 500 pg
Example of a therapeutic group. Various drugs can serve as alternatives.
Essential Drugs
“cioxacillin
WHO Drug Information Vol. 13, No. 4, 1999
capsule, 500 mg, 1 g (as sodium salt)
“metronidazole
tablet 200-500 mg
powder for oral solution, 125 mg
(as sodium salt)/5 ml
injection, 500 mg in 100-ml vial
suppository, 500 mg, 1 g
powder for injection, 500 mg
(as sodium salt) in vial
phenoxymethylpenicillin
tablet, 250 mg
(as potassium salt)
powder for oral suspension. 250 mg
(as potassium salt)/5 ml
procaine benzylpenicillin
powder for injection,
1 g (= 1 million IU),
3 g (= 3 million IU) in vial
oral suspension, 200 mg
(as benzoate)/5 ml
tablet, 250 mg, 500 mg
nalidixic acid (8)
nitrofurantoin (4, 8)
tablet, 100 mg
spectinomycin (8)
powder for injection, 2 g
(as hydrochloride) in vial
tablet. 500 mg
“sulfadiazine (4)
injection, 250 mg (sodium salt)
in 4-ml ampoule
Restricted indications
“amoxicillin +
“clavulanic acid (D)
tablet, 500 mg + 125 mg
tablet. 100 mg + 20 mg.
400 mg + 80 mg
“sulfamethoxazole +
tnmetnoprim (4)
ceftazidime (D)
powder for injection, 250 mg
(as pentahydrate) in vial
oral suspension.
200 mg + 40 mg/5 ml
“ceftriaxone (D)
powder for injection, 250 mg
(as sodium salt) in vial
injection. 80 mg + 16 mglml
in 5-ml and 10-ml ampoule
imipenem +
cilastatm (D)
powder for injection. 250 mg
(as monohydrate) + 250 mg,
(as sodium salt)
500 mg (as monohydrate) +
500 mg in vial (as sodium salt)
6.2.2
trimethopnm (8)
injection. 20 mg/ml
in 5-ml ampoule
Complementary drugs
chloramphenicol (C)
OTHER ANTIBACTERIALS
“chloramphenicol (7)
capsule. 250 mg
oral suspension. 150 mg
(as palmitate)/5 ml
powder for injection, 1 g
(sodium succinate) in vial
tablet. 250 mg
(as hydrochloride)
“ciprofloxacin
capsule or tablet,
100 mg (hydrochloride)
“doxycycline (5. 6)
capsule or tablet. 250 mg
(as stearate or ethyl succinate)
“erythromycin
powder for oral suspension. 125 mg
(as stearate or ethyl succinate)
powder for injection, 500 mg
(as lactobionate) in vial
“gentamicin (2, 4, 7, 11)
injection. 10 mg, 40 mg
(as sulfate)/ml in 2-ml vial
tablet. 100 mg. 200 mg
oily suspension for injection,
0.5 g (as sodium succmate)/ml
in 2-ml ampoule
clindamycin (B) (8)
capsule. 150 mg
injection. 150 mg
(as phosphate)/ml
Restricted indications
vancomycin (D)
powder for injection 250 mg (as
hydrochloride) in vial
6.2.3 ANTILEPROSY DRUGS
clofazimine
capsule. 50 mg, 100 mg
dapsone
tablet. 25 mg. 50 mg, 100 mg
rifampicin
capsule or tablet 150 mg, 300 mg
6.2.4 ANTITUBERCULOSIS DRUGS
ethambutol (4)
isoniazid
isoniazid + ethambutol (5)
“ Example of a therapeutic group. Various drugs can serve as alternatives.
252
tablet. 100-400 mg
(hydrochloride)
tablet. 100-300 mg
tablet. 150 mg + 400 mg
WHO Drug Information Vol. 13, No. 4, 1999
tablet. 400 mg
pyrazinamide
capsule or tablet, 150 mg, 300 mg
rifampicin
rifampicin +
isoniazid (5)
Essential Drugs
6.4.2
ANTIRETROVIRAL DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
tablet, 60 mg + 30 mg, 150 mg + 75 mg,
300 mg+ 150 mg
nevirapine (8)
tablet, 60 mg + 60 mg, 150 mg + 150 mg
(for intermittent use 3 times weekly)
zidovudine (8)
tablet, 200 mg
oral solution, 50 mg/5 ml
capsule. 100 mg, 250 mg
injection, 10 mg/mi in 20-ml vial
tablet,
60 mg + 30 mg + 150 mg,
150 mg + 75 mg + 400 mg
rifampicin + isoniazid +
pyrazinamide (5)
tablet, 150 mg + 150 mg + 500 mg
(for intermittent use 3 times weekly)
rifampicin + isoniazid +
pyrazinamide + ethambutol
tablet. 150 mg + 75 mg +
400 mg + 275 mg
powder for injection.
1 g (as sulfate) in vial
streptomycin (4)
Complementary drug
tablet. 50 mg + 100 mg,
150 mg+ 300 mg
thioacetazone +
isoniazid (A) (5. 7)
I Additional reserve antituberculosis drugs for the treat
ment of drug-resistant tuberculosis should be used in
I specialized centres only with WHO-recommended TB
control strategy. DOTS, and treatment programmes.
oral solution, 50 mg/5 ml
Drugs for treatment of HIV/AIDS include nucleoside
reverse transcriptase inhibitors (NRTIs), non-nucleoside
reverse transcnptase inhibitors (NNRTIs) and protease
inhibitors (Pls). Zidovudine and nevirapine have been
shown to reduce or prevent mother-to-child transmission
of HIV infection. This is the only indication for which
they are included here. Single drug use with zidovudine.
except in pregnancy, is now regarded as obsolete be
cause of the development of resistance. Triple therapy is
beyond the budgets of most national drug programmes
and therelore HIV/AIDS treatment policies must be de
cided at country or institutional level.
6.5
ANTIPROTOZOAL DRUGS
6.5.1
ANTIAMOEBIC AND ANTIGIARDIASIS
DRUGS
° diloxamde
6.3
amphotericin 8 (4)
tablet. 500 mg (furoate)
tablet. 200-500 mg
“metronidazole
ANTIFUNGAL DRUGS
powder for injection. 50 mg in vial
injection, 500 mg in 100-ml vial
capsule. 50 mg
oral suspension. 200 mg
(as benzoate)/5 ml
“fluconazole
injection, 2 mg/ml in vial
oral suspension. 50 mg/5-ml
gnseofulvin (7)
capsule or tablet. 125 mg, 250 mg
6.5.2
ANTILEISHMANIASIS DRUGS
“meglumine antimoniate
injection.
30%. equivalent to approx.
8.5% antimony, in 5-ml ampoule
tablet. 100 000. 500 000 IU
nystatin
lozenge. 100 000 IU
pentamidine (5)
pessary, 100 000 IU
powder for injection. 200 mg,
300 mg (isetionate) in vial
Complementary drug
Complementary drugs
flucytosine (8) (4. 8)
capsule. 250 mg
powder for injection,
50 mg in vial
amphotencm B (B) (4)
infusion, 2.5 g in 250 ml
potassium iodide (A)
saturated solution
6.5.3
ANTIMALARIAL DRUGS
(a) FOR CURATIVE TREATMENT
6.4
ANTIVIRAL DRUGS
6.4.1
ANTIHERPES DRUGS
aciclovir (8)
“chloroquine
tablet, 200 mg
•
powder for injection, 250 mg
(as sodium salt) in vial
tablet. 100 mg, 150 mg
(as phosphate or sulfate)
syrup, 50 mg
(as phosphate or sulfate)/5 ml
injection, 40 mg (as hydro
chloride. phosphate or sulfate)/ml
in 5-ml ampoule
“ Example of a therapeutic group. Various drugs can serve as alternatives.
253
Essential Drugs
WHO Drug Information Vol. 13. No. 4, 1999
tablet. 7.5 mg, 15 mg
(as diphosphate)
primaquine
"quinine
tablet, 300 mg (as bisulfate or sulfate)
injection, 300 mg (as dihydrochloride)/ml
in 2-ml ampoule
tablet. 100 mg
nifurtimox (2, 8)
tablet, 30 mg, 120 mg, 250 mg
6.6 INSECT REPELLENTS
diethyltoluamide
Complementary drugs
"doxycycline (B) (for use only in
capsule or tablet,
combination with quinine)
100 mg (hydrochlonde)
mefloquine (B)
(b) AMERICAN TRYPANOSOMIASIS
benznidazole (7)
tablet. 250 mg (as hydrochlonde)
tablet. 500 mg + 25 mg
"sulfadoxine +
pyrimethamine (B)
Restricted indications
artemether (D)
iniection. 80 mg/ml
in 1-ml ampoule
anesunate (D)
tablet, 50 mg
topical solution, 50%, 75%
Section 7: Antimigraine Drugs
7.1 FOR TREATMENT OF ACUTE ATTACK
acetylsalicylic acid
tablet, 300-500 mg
ergotamine (1c) (7)
tablet. 1 mg (tartrate)
paracetamol
tablet. 300-500 mg
7.2 FOR PROPHYLAXIS
tablet. 20 mg, 40 mg
(hydrochloride)
"propranolol
(b) FOR PROPHYLAXIS
chloroquine
tablet. 150 mg
(as phosphate or sulfate)
syrup. 50 mg (as phosphate
or sulfate)/5 ml
doxycycline
capsule or tablet.
100 mg (hydrochlonde)
mefloquine
tablet, 250 mg (as hydrochlonde)
proguanil (lor use only in
combination with chloroquine)
tablet, 100 mg
(hydrochlonde)
Section 8: Antineoplastic and
Immunosuppressive Drugs and
Drugs Used in Palliative Care
8.1 IMMUNOSUPPRESSIVE DRUGS
Adequate resources and specialist oversight are a pre
requisite tor the introduction of this class ol drugs.
tablet. 50 mg
"azathiopnne (2)
powder for injection. 100 mg
(as sodium salt) in vial
6.5.4 ANTIPNEUMOCYSTOSIS AND
ANTITOXOPLASMOSIS DRUGS
pentamidine (2)
tablet. 200 mg. 300 mg
pyrimethamine
tablet. 25 mg
sulfamethoxazole +
tnmethopnm
injection. 80 mg + 16 mg/ml
in 5-ml and 10-ml ampoule
6.5.5 ANTITRYPANOSOMAL DRUGS
(a) AFRICAN TRYPANOSOMIASIS
melarsoprol (2)
injection. 3.6% solution
pentamidine (2)
powder for injection, 200 mg,
300 mg (isetionate) in vial
suramin sodium
powder for injection, 1 g in vial
concentrate for injection.
50 mg/ml in 1-ml ampoule
8.2 CYTOTOXIC DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
asparaginase (2)
bleomycin (2)
calcium folinate (2)
injection. 200 mg (hydrochloride)/ml in 100-ml bottles
powder for injection. 15 mg
(as sulfate) in vial
tablet. 15 mg
chlorambucil (2)
tablet, 2 mg
chlormethine (2)
powder for injection. 10 mg
(hydrochlonde) in vial
° Example of a therapeutic group. Various drugs can serve as alternatives.
254
powder for injection,
10 000 IU in vial
injection. 3 mg/ml in 10-ml ampoule
Complementary drug
eflomithine (C)
capsule. 25 mg
"ciclosporin (2)
(tor organ transplantation)
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
powder for injection,
10 mg, 50 mg in vial
cisplatin (2)
cyclophosphamide (2)
tablet, 25 mg
Section 9: Antiparkinsonism Drugs
“biperiden
tablet. 2 mg (hydrochloride)
injection, 5 mg (lactate)
in 1-ml ampoule
powder for injection,
500 mg in vial
cytarabine (2)
powder for injection,
100 mg in vial
dacarbazine (2)
powder for injection,
100 mg in vial
daunorubicin (2)
powder for injection.
50 mg (as hydrochloride) in vial
dactinomycin (2)
powder for injection
500 pg in vial
“doxorubicin (2)
etoposide (2)
capsule. 100 mg
levamisole (2)
mercaptopurine (2)
methotrexate (2)
injection. 50 mg/ml
in 5-ml ampoule
tablet. 50 mg
(as hydrochloride)
powder for injection. 50 mg
(as sodium salt) in vial
procarbazine
capsule. 50 mg (as hydrochlonde)
vinblastine (2)
powder for injection.
10 mg (sulfate) in vial
vincnstine (2)
powder for injection.
1 mg, 5 mg (sulfate) in vial
amoxifen
tablet, equivalent to 60 mg iron
oral solution, equivalent to
25 mg iron (as sulfate)/ml
ferrous salt + folic acid
(nutntional supplement for use
during pregnancy)
tablet, equivalent
to 60 mg iron +
400 pg folic acid
folic acid (2)
tablet. 1 mg, 5 mg
injection. 1 mg (as sodium salt)
in 1 -ml ampoule
hydroxocobalamin (2)
injection. 1 mg
in 1-ml ampoule
Complementary drug
“Iron dextran (0) (5)
injection, equivalent to 50 mg
iron/ ml in 2-ml ampoule
10.2 DRUGS AFFECTING COAGULATION
desmopressin (8)
injection. 4 pg (acetate)/ml
in 1-ml ampoule
nasal spray. 10 pg (acetate)/
metered dose
hepann sodium
injection. 1000 lU/ml,
5000 IU/ml. 20 000 lU/ml
in 1-ml ampoule
powder for injection, 20 mg,
25 mg (as sodium phosphate or
sodium succinate) in vial
phytomenadione
injection. 10 mg/ml
in 5-ml ampoule
tablet. 10 mg, 20 mg (as citrate)
protamine sulfate
injection. 10 mg/ml
in 5-ml ampoule
8.3 HORMONES AND ANTIHORMONES
“prednisolone
10.1 ANTIANAEMIA DRUGS
ferrous salt
tablet. 50 mg
tablet. 2.5 mg (as sodium salt)
tablet. 100 mg + 10 mg,
250 mg + 25 mg
Section 10: Drugs affecting the
Blood
powder for injection, 10 mg.
50 mg (hydrochloride) in vial
injection. 20 mg/ml in 5-ml ampoule
fluorouracil (2)
levodopa +
“carbidopa (5, 6)
tablet. 5 mg
tablet. 10 mg
8.4 DRUGS USED IN PALLIATIVE CARE
“warfarin (2. 6)
The WHO Expert Committee on Essential Drugs recom
mended that all the drugs mentioned in the WHO publi
cation Cancer Pain Relief: with a Guide to Opioid Availability, 2nd edition, be considered essential. The drugs
are included in the relevant sections of the model list
according to their therapeutic use, e.g. analgesics.
tablet, 1 mg, 2 mg and 5 mg
(sodium salt)
“ Example of a therapeutic group. Various drugs can serve as alternatives.
255
Essential Drugs
WHO Drug Information Vol. 13, No. 4,1999
Section 11: Blood Products and
Plasma Substitutes
11.1
“procainamide (B)
tablet, 250 mg,
500 mg (hydrochloride)
injection, 100 mg
(hydrochloride)/ml
in 10-ml ampoule
PLASMA SUBSTITUTES
“dextran 70
injectable solution, 6%
“poiygeline
injectable solution, 3.5%
“quinidine (A) (7)
tablet. 200 mg (sulfate)
72.3 ANTIHYPERTENSIVE DRUGS
PLASMA FRACTIONS FOR SPECIFIC USE '
71.2
“atenolol
tablet. 50 mg, 100 mg
Complementary drugs
“factor VIII concentrate (C) (2, 8)
dried
“factor IX complex (coagulation
factors II, VII, IX. X) concentrate (C) (2, 8)
dried
“captopril
scored tablet, 25 mg
“hydralazine
tablet. 25 mg. 50 mg
(hydrochlonde)
powder for injection, 20 mg
(hydrochloride) in ampoule
Section 12: Cardiovascular Drugs
“hydrochlorothiazide
12.1
methyldopa (7)
tablet. 250 mg
“nifedipine (10)
sustained-release formulations
ANTIANGINAL DRUGS
“atenolol
glyceryl tnnitrate
“isosorbide dinitrate
“verapamil (10)
tablet, 50 mg. 100 mg
tablet (sublingual), 500 pg
tablet (sublingual), 5 mg
tablet. 40 mg. 80 mg
(hydrochloride)
72.2 ANTIARRHYTHMIC DRUGS
“atenolol
tablet. 50 mg. 100 mg
digoxin (4. 11)
tablet. 62.5 pg. 250 pg
oral solution, 50 pg/ml
iniection, 250 pg/ml
in 2-ml ampoule
lidocaine
verapamil (8, 10)
scored tablet, 25 mg
tablet. 10 mg
“reserpine
injection, 1 mg in 1-ml ampoule
Complementary drugs
prazosin
injection, 2.5 mg
(hydrochlonde)Zml
in 2-ml ampoule
tablet. 500 pg. 1 mg (mesilate)
“sodium nitroprusside
(C)(2. 8)
scored tablet. 25 mg
digoxin (4. 11)
tablet. 62.5 pg. 250 pg
oral solution. 50 pg/ml
injection. 250 pg/ml in 2-ml ampoule
dopamine
“hydrochlorothiazide
injection, 1 mg
(as hydrochloride)/ml
isoprenaline (C)
injection. 20 pg
(hydrochloride)/ml
injection, 40 mg
(hydrochlonde)rml in 5-ml vial
tablet. 25 mg, 50 mg
72.5 ANTITHROMBOTIC DRUGS
acetylsalicylic acid
Complementary drugs
epinephrine (C)
powder for infusion.
50 mg in ampoule
12.4 DRUGS USED IN HEART FAILURE
“captopril
injection, 20 mg
(hydrochlonde)Zml
in 5-ml ampoule
tablet. 40 mg,
80 mg (hydrochloride)
tablet. 100 pg. 250 pg
tablet. 100 mg
Complementary drug
streptokinase (C)
powder for injection,
100 000 IU, 750 000 IU in vial
“ Example of a therapeutic group. Various drugs can serve as alternatives.
’ All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood. Blood
Components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840, 1994, Annex 2.
256
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
12.6 LIPID-LOWERING AGENTS
13.4 ASTRINGENT DRUGS
The WHO Expert Committee on Essential Drugs recog
nizes the value of lipid-lowering drugs in treating patients
with hyperiipidaemia. Beta-hydroxy-beta-methylglutarylcoenzyme A (HMG CoA) reductase inhibitors, often re
ferred to as 'statins', are potent and effective lipidlowering drugs with a good tolerability profile. Several of
these drugs have been shown to reduce the incidence of
fatal and non-fatal myocardial infarction, stroke and mor
tality (all causes), as well as the need for coronary by
pass surgery. All remain very costly but may be costeffective for secondary prevention of cardiovascular dis
ease as well as for pnmary pre vention in some very highrisk patients. Since no single drug has been shown to be
significantly more effective or less expensive than others
in the group, none is included in the model list: the choice
of drug for use in patients at highest risk should be
decided at national level.
aluminium diacetate
Section 13:
Dermatological Drugs (topical)
solution, 13% for dilution
13.5 DRUGS AFFECTING SKIN
DIFFERENTIATION AND PROLIFERATION
lotion or cream, 5%
benzoyl peroxide
coal tar
solution, 5%
dithranol
ointment, 0.1-2%
fluorouracil
ointment, 5%
"podophyllum resin (7)
solution, 10-25%
salicylic acid
solution 5%
urea
ointment orcream, 10%
13.6 SCAB1CIDES AND PEDICULICIDES
"benzyl benzoate
lotion, 25%
permethrin
cream, 5%
lotion. 1%
13.7 ULTRA VIOLET-BLOCKING AGENTS
13.1 ANTIFUNGAL DRUGS
Complementary drugs
ointment or
cream, 6% ♦ 3%
benzoic acid + salicylic acid
"miconazole
ointment or cream. 2% (nitrate)
sodium thiosulfate
solution, 15%
Complementary drug
detergent-based
suspension. 2%
13.2 ANTI-INFECTIVE DRUGS
"methylrosanilinium chloride
(gentian violet)
aqueous solution. 0.5%
tincture. 0.5%
neomycin + "bacitracin (7)
ointment. 5 mg
neomycin sulfate
+ 500 IU bacitracin zinc/g
potassium permanganate
aqueous solution, 1:10 000
fluorescein
eye drops. 1% (sodium salt)
"tropicamide
eye drops, 0.5%
14.2 RADIOCONTRAST MEDIA
injection. 140-420 mg iodine
(as sodium or meglumine
salt)/ml in 20-ml ampoule
"amidotrizoate
banum sulfate
"iohexol
cream. 1%. in 500-g container
aqueous suspension
injection. 140-350 mg iodine/ml
in 5-ml, 10-ml and 20-ml ampoule
"iopanoic acid
13.3 ANTI-INFLAMMATORY AND
ANTIPRURITIC DRUGS
"betamethasone (3)
Section 14: Diagnostic Agents
14.1 OPHTHALMIC DRUGS
selenium sulfide (C)
silver sulfadiazine
topical sun protection agent with
activity against UVA and UVB (C) cream, lotion or gel
ointment or cream.
0.1% (as valerate)
"calamine lotion
lotion
"hydrocortisone
ointment or cream, 1% (acetate)
"propyliodone
(For administration only into
the bronchial tree).
tablet. 500 mg
oily suspension.
500—600 mg/ml
in 20-ml ampoule
Complementary drug
"meglumine iotroxate (C)
solution, 5 - 8 g iodine
in 100-250 ml
° Example of a therapeutic group. Various drugs can serve as alternatives.
257
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
Section 15:
Disinfectants and Antiseptics
17.2
ANTIEMETIC DRUGS
metoclopramide
tablet. 10 mg (hydrochloride)
injection, 5 mg (hydrochioride)/ml
in 2-ml ampoule
ANTISEPTICS
15.1
solution, 5%
(digluconate) for dilution
“chlorhexidine
“ethanol
solution, 70% (denatured)
“polyvidone iodine
15.2
tablet. 10 mg,
25 mg (hydrochloride)
“promethazine
elixir or syrup, 5 mg
(hydrochloride)/5 ml
solution, 10%
injection. 25 mg (hydrochloride)/ml
in 2-ml ampoule
DISINFECTANTS
“chlonne base compound
powder (0.1% available
chlonne) for solution
“chloroxylenol
solution. 4 8%
glutaral
solution. 2%
“amiionde (4. 7, 8)
ANTIHAEMORRHOIDAL DRUGS
17.4
ointment
or suppository
ANTI-INFLAMMATORY DRUGS
suppository. 25 mg
(acetate)
hydrocortisone
Section 16: Diuretics
“furosemide
17.3
“local anaesthetic, astringent
and anti-inflammatory drug
“ retention enema
tablet, 5 mg (hydrochloride)
tablet. 40 mg
tablet. 500 mg
“sulfasalazine (2)
suppository. 500 mg
injection, 10 mg/ml in
2-ml ampoule
“hydrochlorothiazide
spironolactone (8)
tablet. 25 mg. 50 mg
tablet. 25 mg
retention enema
17.5
ANTISPASMODIC DRUGS
tablet. 0.6 mg (sulfate)
“atropine
injection. 1 mg (sulfate)
in 1-ml ampoule
Complementary drug
“mannitol (C)
injectable solution, 10%. 20%
17.6
Section 17: Gastrointestinal Drugs
17.1
ANTACIDS AND OTHER ANTIULCER
DRUGS
aluminium hydroxide
tablet, 500 mg
oral suspension. 320 mg/5 ml
“cimetidine
tablet, 200 mg
injection, 200 mg in 2-ml ampoule
magnesium hydroxide
oral suspension,
equivalent to 550 mg
magnesium oxide/10 ml
LAXATIVES
tablet. 7.5 mg (sennosides)
(or traditional dosage forms)
“senna
17.7
DRUGS USED IN DIARRHOEA
17.7.1
ORAL REHYDRATION
oral rehydration salts (for glucoseelectrolyte solution)
Components
sodium chloride
trisodium citrate dihydrate 2
potassium chloride
glucose
powder, 27.9 g/l
gA
3.5
2.9
1.5
20.0
“ Example of a therapeutic group. Various drugs can serve as alternatives.
’Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5 g/1. However, as the
stability of this latter formulation is very poor under tropical conditions, it is only recommended when manufactured for
immediate use.
258
WHO Drug Information Vol. 13, No. 4, 1999
17.7.2
ANTIDIARRHOEAL (SYMPTOMATIC)
DRUGS
"codeine (1a)
tablet, 30 mg (phosphate)
Section 18: Hormones, other Endo
crine Drugs and Contraceptives
18.1
ADRENAL HORMONES AND
SYNTHETIC SUBSTITUTES
"dexamethasone
Essential Drugs
18.3.3
BARRIER METHODS
condoms with or without spermicide
(nonoxinol)
diaphragms with spermicide
(nonoxinol)
18.4
ESTROGENS
tablet. 500 pg, 4 mg
injection. 4 mg dexamethasone
phosphate (as disodium salt)
in 1-ml ampoule
hydrocortisone
powder for injection. 100 mg
(as sodium succinate) in vial
“prednisolone
tablet. 1 mg, 5 mg
18.5
INSULINS AND OTHER ANTIDIABETIC
AGENTS
18.2
insulin injection (soluble)
injection.
40 lU/ml in 10-ml vial.
100 lU/ml in 10-ml vial
(as compound insulin zinc suspension
or isophane insulin)
metformin
Complementary drug
testosterone (C) (2)
18.6
injection, 200 mg
(enantate) in 1-ml ampoule
18.3
CONTRACEPTIVES
HORMONAL CONTRACEPTIVES
"ethinylestradiol +
'levonorgestrel
tablet. 30 pg + 150 pg.
"ethinylestradiol +
“levonorgestrel
tablet. 50 pg
+ 250 pg (pack of four)
"ethinylestradiol +
"norethisterone
levonorgestrel
tablet. 35 pg + 1.0 mg
tablet. 0.75 mg (pack of two)
"levonorgestrel (B)
norethisterone
enantate (B) (7, 8)
18.3.2
tablet. 50 mg (citrate)
PROGESTOGENS
tablet. 5 mg
norethisterone
Complementary drug
medroxyprogesterone acetate (8)
Complementary drugs
medroxyprogesterone
acetate (B) (7, 8)
tablet. 500 m (hydrochloride)
OVULATION INDUCERS
"clomifene (2. 8)
18.7
18.3.1
injection,
40 lU/ml in 10-ml vial.
100 lU/ml in 10-ml vial
intermediate-acting insulin
tablet. 100 pg (acetate)
ANDROGENS
tablet. 2.5 mg, 5 mg
"glibendamide
Complementary drug
fludrocortisone (C)
tablet. 10 pg, 50 pg
"ethinylestradiol
18.8
tablet. 5 mg
THYROID HORMONES AND
ANTITHYROID DRUGS
levothyroxine
tablet. 50 pg. 100 pg
(sooium salt)
potassium iodide
tablet. 60 mg
"propylthiouracil
tablet. 50 mg
tablet. 30 pg
depot injection.
150 mg in 1-ml vial
oily solution. 200 mg/ml in
1-ml ampoule
Section 19: Immunologicals
19.1
DIAGNOSTIC AGENTS
tuberculin,3
punfied protein derivative (PPD)
injection
INTRAUTERINE DEVICES
copper-containing device
° Example of a therapeutic group. Various drugs can serve as alternatives.
3 All tuberculins should comply with the Requirements for Tuberculins (Revised 1985). WHO Technical Report Series. No.
745, 1987, Annex 1.
259
Essential Drugs
WHO Drug Information Vol. 13. No. 4, 1999
19.2 SERA AND IMMUNOGLOBULINS ‘
anti-D immunoglobulin
(human)
“antitetanus immunoglobulin
(human)
antivenom serum
diphtheria antitoxin
injection, 250 pg in
single-dose vial
injection, 500 III
in vial
Section 20:
Muscle Relaxants (peripherally acting) and Cholinesterase Inhibitors
injection, 5 mg/ml
in 2-ml ampoule
“alcuronium chloride (2)
injection
injection, 10 000 III,
20 000 IU in vial
immunoglobulin,
human normal (2)
injection (intramuscular)
immunoglobulin,
human normal (2. 8)
injection (intravenous)
“rabies immunoglobulin
injection, 150 lU/ml
tablet,'15 mg (bromide)
“neostigmine
injection, 500 pg. 2.5 mg
(metilsulfate) in 1-ml ampoule
pyridostigmine bromide (2, 8)
tablet, 60 mg
injection, 1 mg
in 1-ml ampoule
injection, 50 mg/ml
in 2-ml ampoule
suxamethonium
chlonde (2)
19.3 VACCINES5
powder for injection
19.3.1 FOR UNIVERSAL IMMUNIZATION
Complementary drug
BCG
vecuronium bromide (C)
powder for injection.
10 mg in vial
diphtheria
pertussis
tetanus
Section 21:
Ophthalmological Preparations
hepatitis B
measles
21.1 ANTI-INFECTIVE AGENTS
“gentamicin
solution (eye drops). 0.3%
(as sulfate)
“idoxuridine
solution (eye drops). 0.1%
influenza
silver nitrate
solution (eye drops), 1%
eye ointment, 1% (hydrochloride)
poliomyelitis
19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS
eye ointment. 0.2%
meningitis
“tetracycline
mumps
21.2 ANTI-INFLAMMATORY AGENTS
rabies
“prednisolone
rubella
solution (eye drops). 0.5%
(sodium phosphate)
typhoid
21.3 LOCAL ANAESTHETICS
yellow fever
“tetracaine
solution (eye drops). 0.5%
(hydrochloride)
21.4 MIOTICS AND ANTIGLAUCOMA DRUGS
acetazolamide
tablet. 250 mg
° Example of a therapeutic group. Various drugs can serve as alternatives.
‘All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood,
Blood components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840, 1994. Annex 2.
5 All vaccines should comply with current WHO recommendations for biological substances.
260
WHO Drug Information Vol. 13, No. 4, 1999
solution (eye drops), 259, 4%
(hydrochloride or nitrate)
“pilocarpine
solution (eye drops), 0.25%, 0.5%
(as maleate)
“timolol
Essential Drugs
24.2
DRUGS USED IN MOOD DISORDERS
24.2.1
DRUGS USED IN DEPRESSIVE
DISORDERS
“amitriptyline
tablet, 25 mg (hydrochloride)
21.5 MYDRIATICS
solution (eye drops),
0.1%, 0.5%, 1% (sulfate)
atropine
Complementary drug
Section 22:
Oxytocics and Antioxytocics
OXYTOCICS
“ergometnne (1c)
tablet. 200 pg (hydrogen maleate)
injection, 200 pg (hydrogen maleate)
in 1-ml ampoule
valproic acid (7, 11)
24.3
enteric coated tablet.
200 mg, 500 mg (sodium salt)
DRUGS USED IN GENERALIZED
ANXIETY AND SLEEP DISORDERS
“diazepam (1b)
24.4
capsule or tablet, 300 mg
scored tablet. 2 mg, 5 mg
DRUGS USED IN OBSESSIVE
COMPULSIVE DISORDERS AND
PANIC ATTACKS
capsules, 10 mg, 25 mg
(hydrochlonde)
clomipramine
ANTIOXYTOCICS
tablet. 4 mg (as sulfate)
“salbutamol (2)
injection. 50 pg (as sulfate)/ml
in 5-ml ampoule
intraperitoneal dialysis solution
(of appropriate composition)
Section 25: Drugs Acting on
the Respiratory Tract
25.1
ANTIASTHMATIC DRUGS
“aminophylline (2)
Section 23: Peritoneal
Dialysis Solution
injection. 25 mg/ml
in 10-ml ampoule
inhalation (aerosol). 50 jig, 250 pg,
(dipropionatel per dose
“beclometasone
parenteral solution
“epinephnne
Section 24:
Psychotherapeutic Drugs
24.1
carbamazepine (10, 11) scored tablet, 100 mg, 200 mg
injection, 10 III in 1-ml ampoule
oxytocin
22.2
DRUGS USED IN BIPOLAR DISORDERS
lithium carbonate (2, 4)
solution (eye drops). 2%
(as hydrochlonde)
epinephnne (A)
22.1
24.2.2
injection. 1 mg (as hydrochlonde
or hydrogen tartrate) in 1-ml ampoule
ipratropium bromide
inhalation (aerosol). 100 ug
(as sulfate) per dose
DRUGS USED IN PSYCHOTIC DISORDERS
“chlorpromazine
“fluphenazine (5)
“haloperidol
inhalation (aerosol). 20 ug/dose
tablet. 2 mg, 4 mg (as sulfate)
“salbutamol
tablet. 100 mg (hydrochloride)
syrup, 2 mg (as sulfate)/5 ml
syruo. 25 mg
(hydrochlonde)/5 ml
injection. 50 jig (as sulfatei/ml
in 5-ml ampoule
injection. 25 mg
(hydrochloride)/ml in 2-ml ampoule
respirator solution for use in nebulizers.
5 mg (as sulfate)/ml
injection. 25 mg
(decanoate or enantate)
in 1-ml ampoule
theophylline (10. 11)
tablet. 2 mg. 5 mg
“cromoglicic acid (0)
injection. 5 mg in
1-ml ampoule
“ Example of a therapeutic group. Vanous drugs can serve
tablet, 100 mg, 200 mg. 300 mg
Complementary drug
inhalation (aerosol),
20 mg (sodium salt) per dose
; alternatives.
261
L
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
26.3 MISCELLANEOUS
25.2 ANTITUSSIVES
oral solution,
3.5 mg (bromide)/5 ml
"dextromethorphan
2-ml, 5-ml, 10-ml ampoules
water for injection
Section 27: Vitamins and Minerals
Section 26:
Solutions correcting Water, Electro
lyte and Acid-base Disturbances
ascorbic acid
tablet, 50 mg
"ergocalciferol
capsule or tablet, 1.25 mg
(50 000 ID)
oral solution,
250 pg/ml (10 000 lU/ml)
26.1 ORAL
oral rehydration salts (for glucoseelectrolyte solution)
for composition
see section 17.7.1
potassium chloride
powder for solution
iodine (8)
solution. 0.57 ml. (308 mg iodine)
in dispenser bottle
26.2 PARENTERAL
glucose
glucose with
sodium chloride
potassium chloride (2)
injectable solution,
5% isotonic. 10% isotonic.
50% hypertonic
injectable solution. 4%
glucose, 0.18% sodium chloride
(equivalent to Na- 30 mmol/l
Cl’ 30 mmol/l)
capsule. 200 mg
tablet. 50 mg
"nicotinamide
pyridoxine
“retinol
tablet, 25 mg (hydrochloride)
sugar-coated tablet. 10 000 III
(as palmitate) (5.5 mg)
capsule, 200 000 III (as
palmitate) (110 mg)
11.2% solution in
20-ml ampoule, (equivalent to
* 1.5 mmol/ml. Cl’ 1.5 mmol/ml)
K
sodium chlonde
injectable solution. 0.9%
isotonic (equivalent to Na' 154
mmol/l. Cl’ 154 mmol/l)
sodium hydrogen
carbonate
injectable solution. 1.4%
isotonic (equivalent to Na- 167
mmol/l, HCO,’ 167 mmol/l)
8 4% solution in 10-ml ampoule
(equivalent to Na- 1000 mmol/l.
HCO.,- 1000 mmol/l)
° compound solution of
sodium lactate
iodized oil. 1 ml (480 mg iodine).
0.5 ml (240 mg iodine) in
ampoule (oral or injectable)
injectable solution
oral oily solution,
100 000 lll/ml in multidose
dispenser (as palmitate)
water-miscible injection.
100 000 III (as palmitate)
(55 mg) in 2-ml ampoule
nbollavm
tablet. 5 mg
“sodium fluoride
in any appropriate formulation
thiamine
tablet. 50 mg (hydrochloride)
Complementary dmg
calcium gluconate (C) (2, 8)
injection,100 mg/ml
in 10-ml ampoule
“ Example of a therapeutic group. Various drugs can serve as alternatives.
The following changes in the WHO Model List were approved by the WHO Expert Committee on
the Use of Essential Drugs which met in December 1999. The report of the meeting will be
published in the WHO Technical Report Series.
Deletions:, albumin (human); antiscorpion sera.
Additions: acetylcysteine; rifampicin + isoniazid + pyrazinamide + ethambutol; nevirapine; artesunate;
chlorambucil; daunorubicin; ethanol; iohexol.
Replacements: fluconazole to replace ketoconazole; prazosin to replace doxazosin.
262
Community Health Cell
From:
"Dr. Hogerzeil" <hogerzeilh@who int>
To:
Sent:
Subject:
"INDIA DRUG" <india-drug@usa.healthnet.org>
Tuesday, May 13, 2003 10:12 PM
[india-drug] 13th WHO Model List of Essential Medicines
(
1.3th WHO Model List of Essential Medicines
Dear all,
The 1.3th WHO Model List of Essential Medicines has been posted on the
WHO/Medicines web site, together with the unedited report of the 13 th
Expert Committee on the Selection and Use of Essential Medicines
(2003), and the summary of their recommendations. All materials can be
found al ihe www. who, mt/medicines website under "latest" and then
"Expert Commitee on the Selection and Use of Essential Medicines". The
direct address is
http://www.who.int/medicines/organi7ation/par/edl/expertcornm.shtrnl .
The main recommendations of the Expert Committee and changes in the
13 th. Model List are summarized below. For (he underlying evidence and
the reasoning of the Committee, please see the original applications
and the report of the Committee.
We are working hard to get the other five language translations of the
Model list on the web; and to adapt the WHO Model Formulary' accordingly
for the 2003 edition.
With best regards,
Hans V. Hogerzeil, MD, PhD, FRCP Edin
Coordinator for policy, access and rational use
Department of Essential Drugs and Medicines Policy
World Health Organisation, 1211 Geneva
Tel 141-22-7913528
Fax +41-22-7914167
<hogerzeilh(®.who. int>
Summary of recommendations of the Expert Committee and changes in the
13th
Model List of Essential Medicines
Added:
- amodiaquine tablet, 153 mg or 200 mg (base);
- azithromycin 250 or 500mg capsule, and suspension 200mg/5ml.
-1.5 mg single levonorgestrel (new dosage form)
Rejected: paediatric ibuprofen, porcine insulin suspension (insulin
semilente), miconazole buccal tablets, misoprostol and valaciclovir.
Page 2 of 4
Deleted:
- ethinylestradiol + levonorgestrel tablet, 50 micrograms + 250
micrograms
(pack of four)
- nonoxinol and spermicides with condoms and diaphragms
- chloral hydrate
- dextromethorphan
- fludrocortisone
- folic acid injection
- ipecacuanha syrup
- human immunoglobulin
- pethidine
- cyclophosphamide in section 2.4
- trimethoprim injection
- iron dextran injection
- prazosin
- hydralazine
- reserpine
- desmopressin
Changed:
- OPS to 75 inFq/1 sodium (sodium chloride 2.6 g/liter) and 75 mmol/I
(13.5 g/liter) glucose
- streptokinase: dosage changed to powder for injection 1.5 million IU
in vial.
The Committee decided to define the criteria for core and complementary
lists, as follows:
The core list presents a list of minimum medicine needs for a basic
health care system, listing the most efficacious, safe and cost
effective medicine for priority conditions. Priority' conditions are
selected on the basis of current and estimated future public health
relevance, and potential for safe and cost-effective treatment.
The complementary list presents essential medicines for priority
diseases.for which specialized diagnostic or monitoring facilities,
and/or specialist medical care, and/or specialist training are needed.
In case of doubt medicines may also be listed as complementary' on the
basis of consistent higher costs or less attractive cost-effectiveness
in a variety of settings.
The Committee recommended that the core and complementary list be
combined as one, with medicines on the complementary list printed in
italics or otherwise identified.
Moved from the core list to the complementary list:
amphotericin-R, aminophylline, azathioprine, clomifene,
diethylcarbamazine.dopamine, ethosuximide, hydrocortisone rectal
preparations, intraperitoneal dialysis solution, methotrexate,
penicillamine, pentamidine, pyridostigmine,sulfadiazine and
sulfasalazine.
Moved from the complementary list to the core list:
amoxicillin/clavulanic acid, chloramphenicol oily solution, epinephrine
5/14/03
Page 3 of 4
(adrenaline) injection, levonorgestrel, mannitol and norcthistcrone
enantate.
The Committee agreed to use the square box symbol on the basis of the
following description:
"The square box symbol is primarily intended to indicate similar
clinical performance within a pharmacological class. The listed
medicine should be the example of the class for which there is the best
evidence for effectiveness and safety, in some cases, this may be the
first medicine that is licensed for marketing; in other instances,
subsequently licensed compounds may be safer or more effective. Where
there is no difference in terms of efficacy and safety data, the listed
medicine should be the one that is generally available at the lowest
price, based on international drug price information sources.
Therapeutic equivalence is only indicated on the basis of reviews of
efficacy and safety and when consistent with WHO clinical guidelines.
National lists should not use a similar symbol and should be specific
in their final selection, which would depend on local availability and
price."
Square box symbol removed:
amiloride, amoxicillin, amoxicillin/clavulinic acid, antitetanus
immunoglobulin, azalhioprine, chloramphenicol, chloroquine.
ciclosporin.clomifene. charcoal activated, codeine, cycloserine,
dexamethasone, diloxanidc, DL-mcthioninc, doxorubicin, doxycycline,
epinephrine/adrenaiine.ethtonamide, hydrocortisone, glibenclamide,
ibuprofen, mannitol, morphine,neostigmine, promethazine, quinine,
sodium nitroprusside, retinol,sulfadiazine, sulfadoxine/pyrimelhamine,
sulfamethoxazole/trimethoprim and verapamil.
Square box symbol retained but listed medicine changed:
- cioxacillin to be replaced by dicloxacillin
- captopril to be replaced by enalapril
- cimetidine to be replaced by ranitidine
Review of corticosteroids:
Core list: section 3:
- prednisolone tablets 5mg and 25mg with square box
- dexamethasone, injection 4mg dexamethasone phosphate (as disodium
salt) in 1ml
- hydrocortisone, powder for injection, lOOmg (as sodium succinate) in
vial both
Complementary list, section 8.3: same items listed
Section 18.1: all corticosteroids deleted
Review of antihypertensive drags:
Deleted: reserpine, hydralazine and prazosin
Captopril be replaced by enalapril with square box
Critical review to be carried out of the justification of the use of
dihydropyridine calcium channel blockers as first-line treatment for
hypertension.
Meihyldopa kept on core list, but only for use in pregnancy
In summary, the Committee recommended that boxed atenolol tablet 50mg,
5/14/03
Page 4 of 4
lOOmg; enalapril tablet 25mg; boxed hydrochlorothiazide scored tablet
25mg;
methyldopa tablet 250mg and boxed nifedipine be listed on the core list
of
section 12.3; and that sodium nitroprusside, powder for infusion, 50mg
in
ampoule be listed on the complementary list.
Proposals for fast-track deletion in 2004
Ether, codeine, colchicine, clonazepam, niclosamide, pyrantel.
triclabendazole, oxamniquine, imipenem/cilastatin, nalidixic acid,
spectinomycin, levofloxacin, ihioacetazone/isoniazid, diethyltoluamidc,
ergotamine, polygeline, Factors VUI and IX, isoprenaline,
procainamide,quinidine, nifedepine, topical sun protection agent, local
anaeslhelic/aslringenl ointment, atropine in section 17.4.
medroxyprogesterone acetate, silver nitrate eye solution, ergometrine.
salbutamol in section 22.2.2, aminophyllinc, cromoglicic acid, calcium
gluconate and sodium fluoride.
The Committee recommended that these items be marked in the list with
the following footnote: "The public health relevance and/or efficacy
and/or safety of thi s item has been questioned and its continued
inclusion on tire list will be reviewed at the next meeting of the
Expert. Committee.
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5/14/03
A
R
O
G
R
A
M
M
E
O
F
T
H
E
Delhi
Society for
Promotion of
Rational
Use of Drugs
A Programme on Rational Use of Drugs
Rational Use of brugs or
RUb is a sensible and
What is
Rational
use of
Drugs ?
reasonable way for
patients to
receive
medicines. Medicines are
necessary for prevention
and cure of their medical
condition, in appropriate
doses and for a suitable
time
period.
Most
importantly, availability of
quality
medicines,
independent of where
they live in India, at the
cheapest rates.
Cost of same drug in different years for
Delhi government hospitals
Pooled procurement rate
2002
1993
Name of Drug
Cap. Amoxycillin
(500 mg.)
Rs.21.50 per 10
Rs.13.83 per 10
Cap. Ciprofloxacin
(500 mg.)
Rs.24.30 per 10
Rs.9.48 per 10
Inj. Ceftazidime
(1 gm.)
Rs. 214
per vial
Rs. 62.15
per vial
Inj. Streptokinase
(15 M.U.)
Rs. 1770.00
per inj.
Rs. 885.00
per inj.
Holding the price tine
Is there scope for
change ?
„
r„
Cost advantage in supply of essential
drugs by pooled procurement
Drugs
Open
tender
Pooled
procurement
% cost
reduction
Syr Amoxycillin
14.65
7.50
50
Tab Erythromycin
(250mg)
3.24
1.54
50
Tab Atenolol
(50mg)
0.42
0.17
60
Inj Ranitidine
1.87
1.63
12.50
Inj Diazepam
5.53
0.93
80
Good medical care means
access to and availability
of medicines for the sick
and needy. Although, a
good percentage of the
health budget state-wise
is allocated for providing
drugs, we are faced with
the problem of shortages
and
even
spurious
medicines at public health
facilities.
Lack of
medicines is a constraint
to health care. This has a
direct effect on the
economic health of India.
Medical
Care:
The
present
status
The answer is 'Yes’. There is a working model already in place.
This model can improve the quality of therapy, reduce wastage in
resources, limit unnecessary expenditure and minimize adverse
side effects. Specifically designed to educate the patient, the
model chooses the 'best' for health care.
oom
The ‘Delhi Model' is a joint initiative on
the rational use of drugs between the
‘World Health Organization' (WHO),
Model:
a success
story
DSPRUD and the Government of Delhi.
Today, patients in Delhi State Hospitals
receive free good quality medicines.
Ninety percent of drugs prescribed
Problems faced
prior to the Model
are actually handed out to patients.
Before 1993:
•
WHO India Essential Drugs Programme:
Expansion of Delhi programme into other states
executed through DSPfiUD
Drugs when available were of
poor quality
•
Components
State drug policy
Essential drugs list by level of care
Pooled procurement
Prescribeddrugsnotavailableor
in short supply
Stocking of unnecessary drugs
and combinations
Inadequate quality control
mechanism
No state list of essential drugs;
each hospital has its own list
Efficient distribution
Quality assurance
Information to patients & prescribers
Training in rational prescribing
Drugs procured and distributed
in a disorganized way
Doctor's prescriptions resulted
in use of expensive brand names
Studies on drug use,
pharmacoeconomics
No information given to the
patients on how to use
prescribed drugs
About
DSPRUD
The Delhi Society for
Promotion of Rational Use
of Drugs, DSPRUD in
short, is a registered
Society with its office in
New Delhi. DSPRUD,
headed by Prof. Ranjit Roy
Chaudhury,
eminent
clinical pharmacologist
with a team of committed
professionals, implement
the programme.
Estimates of potential savings from
drug policy
Avg. Worth
Rs.
%
Selection of drugs EML
Quantification of requirment
Procurement by generic names
Use of competitive bidding system
Proper storage conditions
Good inventory management
Reduction of theft and pilferage
Rational prescription
Improved patient compliance
10
15
25
10
10
15
20
1.10
1.26
1.58
1.75
1.92
2.20
2.64
3.96
_
Developing a Drug Policy
Selecting an Essential Medicines List
RUD’s
steps
to
success
Pooled procurement of medicines by a
Central Committee
Establishment of a quality assurance
system
Preparation of a Drug Formulary
Preparation of Standard Treatment
Guidelines
Training at all levels for those who
administer health care in rational
prescribing of medicines
Objective information about medicines
to doctors and patients
Research and monitoring all aspects of
drug use
Results from the
RUD programme
Drug prices contained over the
years
Drugs can be purchased at 35%
cheaper rates with pooled
procurement
Impact on drug quality in public facilities:
Results of quality tests (Delhi State)
Total no. of batches tested
(July 2000 to October 2002)
3529
Batches not of standard quality
28 (0.79%)
Total expenditure
0.53% of
the budget
for drugs
90% of prescribed drugs from
list of essential medicines
Additional savings can be made
by use of Standard Treatment
Guidelines.
Quality of drugs distributed in
government hospitals is
ensured
Increased accessibility with
90% of medicines being
dispensed in public health
facilities
Quality of prescribing is good
Improved prescribing- not
more than three medicines on
an average
Medicines actually dispensed at
various level of health facilities
- Delhi 2002
Impact on rational! prescribing :
Medicines prescribed from EML- Delhi 2002
Make India Healthy
Make India Wealthy
Adopt RUD
The expertise of the Delhi Society for
Promotion of Rational Use of Drugs
is
available for introducing the ’Delhi Model' in any
State or any organization.
Delhi Society for Promotion of Rational Use of Drugs
(Registered under Societies Registration Act of 1860, Regn. No. S 30330 of 1996)
National Institute of Immunology
Aruna Asaf Ali Marg, New Delhi 110 067
Phone : 617 9638, 616 2281,616 3009 • Telefax: 616 5776
E-mail: dsprud@satyam.net.in • Website : www.dsprud.org
T P- - I C( .
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
WHO Model List (revised December 1999)
injection for spinal anaesthesia,
0.5% (hydrochloride) in 4-ml ampoule
to be mixed with 7.5% glucose solution
Section 1: Anaesthetics
1.1
GENERAL ANAESTHETICS AND OXYGEN
ether, anaesthetic (1c) (2)
inhalation
halothane (2)
inhalation
ketamine (2)
injection, 50 mg (as hydrochloride)/ml in 10-ml vial
injection for spinal anaesthesia,
5% (hydrochloride) in 2-ml ampoule
to be mixed with 7.5% glucose solution
inhalation (medicinal gas)
oxygen
“thiopental (2)
topical forms, 2-4% (hydrochloride)
powder for injection, 0.5 g, 1.0 g
(sodium salt) in ampoule
LOCAL ANAESTHETICS
“bupivacaine (2, 9)
injection, 0.25%, 0.5%
(hydrochloride) in vial
injection, 1%, 2%
(hydrochloride) in vial
injection, 1 %, 2% (hydrochloride)
+ epinephrine 1:200 000 in vial
inhalation
nitrous oxide (2)
1.2
“lidocaine
dental cartridge, 2% (hydrochloride)
+ epinephrine 1:80 000
Complementary drug
ephedrine (C)
injection, 30 mg
(For use in spinal anaesthesia
(hydrochloride)/ml in
during delivery to prevent hypotension)
1 -ml ampoule
° Example of a therapeutic group. Various drugs can serve as alternatives.
Explanatory Notes
When the strength of a drug is specified in terms of a
selected salt or ester, this is mentioned in brackets; when it
refers to the active moiety, the name of the salt or ester in
brackets is preceded by the word "as".
Many drugs included in the list are preceded by a box (°) to
indicate that they represent an example of a therapeutic
group and that various drugs could serve as alternatives. It
is imperative that this is understood when drugs are selected
at national level, since choice is then influenced by the
comparative cost and availability of equivalent products.
Examples of acceptable substitutions include:
° Hydrochlorothiazide: any other thiazide-type diuretic cur
rently in broad clinical use.
“ Hydralazine: any other peripheral vasodilator having an
antihypertensive effect.
“ Senna: any stimulant laxative (either synthetic or of plant
origin).
“ Sulfadiazine: any other short-acting, systemically active
sulfonamide unlikely to cause crystalluria.
United Nations Convention against Illicit Traffic in Narcotic
Drugs and Psychotropic Substances (1988).
(2)
Specific expertise, diagnostic precision, individualization
of dosage or special equipment required for proper use.
(3)
Greater potency or efficacy.
(4)
In renal insufficiency, contraindicated or dosage adjust
ments necessary.
(5)
To improve compliance.
(6)
Special pharmacokinetic properties.
(7)
Adverse effects diminish benefit/risk ratio.
(8)
Limited indications or narrow spectrum of activity.
(9)
For epidural anaesthesia.
(10)
Sustained-release preparations are available. A pro
posal to include such a product in a national list of essential
drugs should be supported by adequate documentation.
(11)
Monitoring of therapeutic concentrations in plasma can
improve safety and efficacy.
Letters in parentheses following the drug names indicate the
reasons for the inclusion of complementary drugs:
(A)
When drugs in the main list cannot be made available.
(B)
When drugs in the main list are known to be ineffective or
inappropriate for a given individual.
Numbers in parentheses following drug names indicate:
(C)
For use in rare disorders or in exceptional circumstances.
(1)
Drugs subject to international control under: (a) the (D)
Reserve antimicrobials to be used only when there is
Single Convention on Narcotic Drugs (1961); (b) the Con
significant resistance to other drugs on the list.
vention on Psychotropic Substances (1971); or (c) the
Drugs are listed in alphabetical order.
249
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
1.3 PREOPERATIVE MEDICATION & SEDATION
FOR SHORT-TERM PROCEDURES
2.4 DISEASE-MODIFYING AGENTS USED
IN RHEUMATIC DISORDERS
atropine
azathioprine (2)
tablet, 50 mg
chloroquine (2)
tablet, 100 mg, 150 mg
(as phosphate or sulfate)
injection, 1 mg (sulfate)
in 1-ml ampoule
chloral hydrate
syrup, 200 mg/5 ml
“diazepam (1b)
injection, 5 mg/ml
in 2-ml ampoule
tablet, 5 mg
injection, 10 mg (sulfate or
hydrochloride) in 1-ml ampoule
"morphine (1a)
elixir or syrup, 5 mg
(hydrochloride)/5 ml
“promethazine
Section 2: Analgesics, Antipyretics,
Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs), Drugs Used to
Treat Gout and Disease-Modifying
Agents used in Rheumatic
Disorders (DMARDs)
2.1
NON-OPIOID ANALGESICS & NSAIDs
cyclophosphamide (2)
tablet, 2.5 mg (as sodium salt)
penicillamine (2)
capsule or tablet, 250 mg
sulfasalazine (2)
tablet, 500 mg
Section 3: Antiallergics and
Drugs Used in Anaphylaxis
tablet, 4 mg (hydrogen maleate)
“chlorphenamine
injection, 10 mg (hydrogen
maleate) in 1-ml ampoule
tablet, 500 pg, 4 mg
"dexamethasone
injection, 4 mg
dexamethasone phosphate
(as disodium salt) in 1-ml ampoule
epinephrine
injection, 1 mg (as hydro
chloride or hydrogen tartrate)
in 1-ml ampoule
hydrocortisone
powder for injection, 100 mg
(as sodium succinate) in vial
“prednisolone
tablet, 5 mg
tablet, 100-500 mg
acetylsalicylic acid
suppository, 50-150 mg
tablet, 200 mg, 400 mg
"ibuprofen
tablet, 100-500 mg
paracetamol
tablet, 25 mg
methotrexate (2)
suppository, 100 mg
syrup, 125 mg/5 ml
2.2
OPIOID ANALGESICS
"codeine (1a)
tablet, 30 mg (phosphate)
“morphine (1a)
injection, 10 mg (sulfate or
hydrochloride) in 1-ml ampoule
oral solution, 10 mg (hydrochloride
or sulfate))/5 ml
tablet, 10 mg (sulfate)
4.1 NON-SPECIFIC
“charcoal, activated
ipecacuanha
4.2
injection, 50 mg
(hydrochloride) in 1-ml ampoule
SPECIFIC
atropine
tablet, 50 mg, 100 mg (hydrochloride)
calcium gluconate (2, 8)
2.3
DRUGS USED TO TREAT GOUT
allopurinol (4)
tablet, 100 mg
colchicine (7)
tablet, 500 pg
deferoxamine
“ Example of a therapeutic group. Various drugs can serve as alternatives.
250
powder
syrup, containing 0.14% ipecacuanha
alkaloids calculated as emetine
acetylcysteine
Complementary drug
“pethidine (A) (1a, 4)
Section 4: Antidotes and Other
Substances Used in Poisonings
injection, 200 mg/ml
in 10-ml vial
injection, 1 mg (sulfate)
in 1-ml ampoule
injection, 100 mg/ml
in 10-ml ampoule
powder for injection, 500 mg
(mesilate) in vial
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
dimercaprol (2)
injection in oil, 50 mg/ml
in 2-ml ampoule
“□L-methionine
tablet, 250 mg
injection, 10 mg/ml
in 10-ml ampoule
methylthioninium chloride
(methylene blue)
injection, 400 pg (hydrochloride)
in 1-ml ampoule
naloxone
capsule or tablet, 250 mg
penicillamine (2)
potassium ferric hexacyanoferrate(ll) -2H2O (Prussian blue)
powder for oral
administration
sodium calcium edetate (2)
injection, 200 mg/ml
in 5-ml ampoule
sodium nitrite
injection, 30 mg/ml
in 10-ml ampoule
sodium thiosulfate
injection, 250 mg/ml
in 50-ml ampoule
Section 6: Anti-infective Drugs
6.1 ANTHELMINTHICS
6.1.1
INTESTINAL ANTHELMINTHICS
albendazole
chewable tablet, 400 mg
levamisole
tablet, 50 mg, 150 mg
(as hydrochloride)
“mebendazole
chewable tablet, 100 mg, 500 mg
niclosamide
chewable tablet, 500 mg
praziquantel
tablet, 150 mg, 600 mg
pyrantel
chewable tablet, 250 mg
(as embonate)
oral suspension, 50 mg
(as embonate)/ml
6.1.2
ANTIFILARIALS
tablet, 50 mg, 100 mg
(dihydrogen citrate)
diethylcarbamazine
Section 5: Anticonvulsants/
Antiepileptics
ivermectin
carbamazepine (10, 11) scored tablet, 100 mg, 200 mg
suramin sodium (B) (2, 7)
injection, 5 mg/ml in 2-ml
ampoule (intravenous or rectal)
"diazepam (1b)
ethosuximide
6.1.3
capsule, 250 mg
magnesium sulfate
phenobarbital (1b, 11)
scored tablet, 3 mg, 6 mg
Complementary drug
powder for injection,
1 g in vial
ANTISCHISTOSOMALS AND OTHER
ANTITREMATODE DRUGS
syrup, 250 mg/5 ml
praziquantel
tablet, 600 mg
injection, 500 mg/ml
in 2-ml ampoule
and 10-ml ampoule
triclabendazole
tablet, 250 mg
Complementary drug
oxamniquine (C) (8)
capsule, 250 mg
tablet, 15-100 mg
syrup, 250 mg/5 ml
elixir, 15 mg/5 ml
phenytoin (7, 11)
capsule or tablet,
25 mg, 50 mg, 100 mg (sodium salt)
injection, 50 mg
(sodium salt)/ml in 5-ml vial
valproic acid (7, 11)
ANTIBACTERIALS
BETA LACTAM DRUGS
“amoxicillin
capsule or tablet, 250 mg,
500 mg (anhydrous)
powder for oral suspension,
125 mg (anhydrous)/5 ml
enteric coated tablet,
200 mg, 500 mg (sodium salt)
Complementary drug
"clonazepam (B) (1b)
6.2
6.2.1
ampicillin
powder for injection, 500 mg,
1 g (as sodium salt) in vial
benzathine
benzylpenicillin
powder for injection,
1.44 g benzylpenicillin
(= 2.4 million IU) in 5-ml vial
benzylpenicillin
powder for injection,
600 mg (= 1 million IU),
3 g (= 5 million IU)
(sodium or potassium salt) in vial
scored tablet, 500 pg
“ Example of a therapeutic group. Various drugs can serve as alternatives.
251
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
“doxacillin
capsule, 500 mg, 1 g (as sodium salt)
“metronidazole
tablet, 200-500 mg
powder for oral solution, 125 mg
(as sodium salt)/5 ml
injection, 500 mg in 100-ml vial
powder for injection, 500 mg
(as sodium salt) in vial
oral suspension, 200 mg
(as benzoate)/5 ml
phenoxymethylpenicillin
tablet, 250 mg
(as potassium salt)
powder for oral suspension, 250 mg
(as potassium salt)/5 ml
procaine benzylpenicillin
powder for injection,
1 g (= 1 million IU),
3 g (= 3 million IU) in vial
suppository, 500 mg, 1 g
tablet, 250 mg, 500 mg
nalidixic acid (8)
nitrofurantoin (4, 8)
tablet, 100 mg
spectinomycin (8)
powder for injection, 2 g
(as hydrochloride) in vial
tablet, 500 mg
“sulfadiazine (4)
injection, 250 mg (sodium salt)
in 4-ml ampoule
Restricted indications
“amoxicillin +
"clavulanic acid (D)
tablet, 500 mg + 125 mg
tablet, 100 mg + 20 mg,
400 mg + 80 mg
“sulfamethoxazole +
trimethoprim (4)
ceftazidime (D)
powder for injection, 250 mg
(as pentahydrate) in vial
oral suspension,
200 mg + 40 mg/5 ml
“ceftriaxone (D)
powder for injection, 250 mg
(as sodium salt) in vial
injection, 80 mg + 16 mg/ml
in 5-ml and 10-ml ampoule
imipenem +
cilastatin (D)
powder for injection, 250 mg
(as monohydrate) + 250 mg,
(as sodium salt)
500 mg (as monohydrate) +
500 mg in vial (as sodium salt)
6.2.2
injection, 20 mg/ml
in 5-ml ampoule
Complementary drugs
chloramphenicol (C)
OTHER ANTIBACTERIALS
“chloramphenicol (7)
capsule, 250 mg
oral suspension, 150 mg
(as palmitate)/5 ml
powder for injection, 1 g
(sodium succinate) in vial
tablet, 250 mg
(as hydrochloride)
“ciprofloxacin
capsule or tablet,
100 mg (hydrochloride)
“doxycycline (5, 6)
capsule or tablet, 250 mg
(as stearate or ethyl succinate)
“erythromycin
powder for oral suspension, 125 mg
(as stearate or ethyl succinate)
powder for injection, 500 mg
(as lactobionate) in vial
“gentamicin (2, 4, 7, 11)
injection, 10 mg, 40 mg
(as sulfate)/ml in 2-ml vial
tablet, 100 mg, 200 mg
trimethoprim (8)
oily suspension for injection,
0.5 g (as sodium succinate)/ml
in 2-ml ampoule
capsule, 150 mg
clindamycin (B) (8)
injection, 150 mg
(as phosphate)/ml
Restricted indications
vancomycin (D)
powder for injection 250 mg (as
hydrochloride) in vial
6.2.3 ANTILEPROSY DRUGS
capsule, 50 mg, 100 mg
clofazimine
dapsone
tablet, 25 mg, 50 mg, 100 mg
rifampicin
capsule or tablet, 150 mg, 300 mg
6.2.4
ANTITUBERCULOSIS DRUGS
ethambutol (4)
isoniazid
isoniazid + ethambutol (5)
” Example of a therapeutic group. Various drugs can serve as alternatives.
252
tablet, 100-400 mg
(hydrochloride)
tablet, 100-300 mg
tablet, 150 mg + 400 mg
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
tablet, 400 mg
pyrazinamide
capsule or tablet, 150 mg, 300 mg
rifampicin
rifampicin +
isoniazid (5)
6.4.2
ANTIRETROVIRAL DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
tablet, 60 mg + 30 mg, 150 mg + 75 mg,
300 mg + 150 mg
nevirapine (8)
tablet, 60 mg + 60 mg, 150 mg + 150 mg
(for intermittent use 3 times weekly)
zidovudine (8)
tablet, 200 mg
oral solution, 50 mg/5 ml
capsule, 100 mg, 250 mg
injection, 10 mg/ml in 20-ml vial
tablet,
60 mg + 30 mg + 150 mg,
150 mg + 75 mg + 400 mg
rifampicin + isoniazid +
pyrazinamide (5)
tablet, 150 mg + 150 mg + 500 mg
(for intermittent use 3 times weekly)
tablet, 150 mg + 75 mg +
400 mg + 275 mg
rifampicin + isoniazid +
pyrazinamide + ethambutol
powder for injection,
1 g (as sulfate) in vial
streptomycin (4)
Complementary drug
tablet, 50 mg + 100 mg,
150 mg + 300 mg
thioacetazone +
isoniazid (A) (5, 7)
Additional reserve antituberculosis drugs for the treat
ment of drug-resistant tuberculosis should be used in
specialized centres only with WHO-recommended TB
control strategy, DOTS, and treatment programmes.
oral solution, 50 mg/5 ml
Drugs for treatment of HIV/AIDS include nucleoside
reverse transcriptase inhibitors (NRTIs), non-nucleoside
reverse transcriptase inhibitors (NNRTIs) and protease
inhibitors (Pls). Zidovudine and nevirapine have been
shown to reduce or prevent mother-to-child transmission
of HIV infection. This is the only indication for which
they are included here. Single drug use with zidovudine,
except in pregnancy, is now regarded as obsolete be
cause of the development of resistance. Triple therapy is
beyond the budgets of most national drug programmes
and therefore HIV/AIDS treatment policies must be de
cided at country or institutional level.
6.5
ANTIPROTOZOAL DRUGS
6.5.1 ANTIAMOEBIC AND ANTIGIARDIASIS
DRUGS
tablet, 500 mg (furoate)
° diloxanide
6.3
amphotericin B (4)
tablet, 200-500 mg
"metronidazole
ANTIFUNGAL DRUGS
powder for injection, 50 mg in vial
injection, 500 mg in 100-ml vial
capsule, 50 mg
oral suspension, 200 mg
(as benzoate)/5 ml
"fluconazole
injection, 2 mg/ml in vial
oral suspension, 50 mg/5-ml
griseofulvin (7)
capsule or tablet, 125 mg, 250 mg
nystatin
6.5.2
ANTILEISHMANIASIS DRUGS
injection,
30%, equivalent to approx.
8.5% antimony, in 5-ml ampoule
“meglumine antimoniate
tablet, 100 000, 500 000 IU
lozenge, 100 000 IU
pentamidine (5)
pessary, 100 000 IU
powder for injection, 200 mg,
300 mg (isetionate) in vial
Complementary drug
Complementary drugs
flucytosine (B) (4, 8)
capsule, 250 mg
amphotericin B (B) (4)
powder for injection,
50 mg in vial
infusion, 2.5 g in 250 ml
saturated solution
potassium iodide (A)
6.5.3
ANTIMALARIAL DRUGS
(a) FOR CURATIVE TREATMENT
6.4
ANTIVIRAL DRUGS
"chloroquine
6.4.1 ANTIHERPES DRUGS
aciclovir (8)
tablet, 200 mg
powder for injection, 250 mg
(as sodium salt) in vial
tablet, 100 mg, 150 mg
(as phosphate or sulfate)
syrup, 50 mg
(as phosphate or sulfate)/5 ml
injection, 40 mg (as hydro
chloride, phosphate or sulfate)/ml
in 5-ml ampoule
° Example of a therapeutic group. Various drugs can serve as alternatives.
253
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Essential Drugs
primaquine
tablet, 7.5 mg, 15 mg
(as diphosphate)
tablet, 300 mg (as bisulfate or sulfate)
"quinine
injection, 300 mg (as dihydrochloride)/ml
in 2-ml ampoule
benznidazole (7)
tablet, 100 mg
nifurtimox (2, 8)
tablet, 30 mg, 120 mg, 250 mg
6.6 INSECT REPELLENTS
diethyltoluamide
Complementary drugs
"doxycycline (B) (for use only in
capsule or tablet,
combination with quinine)
100 mg (hydrochloride)
mefloquine (B)
(b) AMERICAN TRYPANOSOMIASIS
tablet, 250 mg (as hydrochloride)
tablet, 500 mg + 25 mg
"sulfadoxine +
pyrimethamine (B)
Restricted indications
artemether (D)
injection, 80 mg/ml
in 1-ml ampoule
tablet, 50 mg
artesunate (D)
topical solution, 50%, 75%
Section 7: Antimigraine Drugs
7.1 FOR TREATMENT OF ACUTE ATTACK
acetylsalicylic acid
tablet, 300-500 mg
ergotamine (1c) (7)
tablet, 1 mg (tartrate)
tablet, 300-500 mg
paracetamol
7.2 FOR PROPHYLAXIS
tablet, 20 mg, 40 mg
(hydrochloride)
“propranolol
(b) FOR PROPHYLAXIS
tablet, 150 mg
(as phosphate or sulfate)
chloroquine
syrup, 50 mg (as phosphate
or sulfate)/5 ml
doxycycline
capsule or tablet,
100 mg (hydrochloride)
mefloquine
tablet, 250 mg (as hydrochloride)
tablet, 100 mg
(hydrochloride)
proguanil (for use only in
combination with chloroquine)
Section 8: Antineoplastic and
Immunosuppressive Drugs and
Drugs Used in Palliative Care
8.11MMUNOSUPPRESSIVE DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
tablet, 50 mg
“azathioprine (2)
powder for injection, 100 mg
(as sodium salt) in vial
6.5.4 ANTIPNEUMOCYSTOSIS AND
ANTITOXOPLASMOSIS DRUGS
pentamidine (2)
tablet, 200 mg, 300 mg
pyrimethamine
tablet, 25 mg
sulfamethoxazole +
trimethoprim
injection, 80 mg + 16 mg/ml
in 5-ml and 10-ml ampoule
6.5.5 ANTITRYPANOSOMAL DRUGS
(a) AFRICAN TRYPANOSOMIASIS
melarsoprol (2)
injection, 3.6% solution
pentamidine (2)
powder for injection, 200 mg,
300 mg (isetionate) in vial
suramin sodium
powder for injection, 1 g in vial
“ciclosporin (2)
(for organ transplantation)
8.2 CYTOTOXIC DRUGS
Adequate resources and specialist oversight are a pre
requisite for the introduction of this class of drugs.
asparaginase (2)
bleomycin (2)
calcium folinate (2)
injection, 200 mg (hydrochloride)/ml in 100-ml bottles
powder for injection, 15 mg
(as sulfate) in vial
tablet, 15 mg
chlorambucil (2)
tablet, 2 mg
chlormethine (2)
powder for injection, 10 mg
(hydrochloride) in vial
" Example of a therapeutic group. Various drugs can serve as alternatives.
254
powder for injection,
10 000 IU in vial
injection, 3 mg/ml in 10-ml ampoule
Complementary drug
eflornithine (C)
capsule, 25 mg
concentrate for injection,
50 mg/ml in 1-ml ampoule
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
powder for injection,
10 mg, 50 mg in vial
cisplatin (2)
cyclophosphamide (2)
tablet, 25 mg
Section 9: Antiparkinsonism Drugs
“biperiden
tablet, 2 mg (hydrochloride)
injection, 5 mg (lactate)
in 1-ml ampoule
powder for injection,
500 mg in vial
cytarabine (2)
powder for injection,
100 mg in vial
dacarbazine (2)
powder for injection,
100 mg in vial
daunorubicin (2)
powder for injection,
50 mg (as hydrochloride) in vial
dactinomycin (2)
powder for injection
500 pg in vial
“doxorubicin (2)
powder for injection, 10 mg,
50 mg (hydrochloride) in vial
tablet, 100 mg + 10 mg,
250 mg + 25 mg
levodopa +
“carbidopa (5, 6)
Section 10: Drugs affecting the
Blood
10.1 ANTIANAEMIA DRUGS
etoposide (2)
capsule, 100 mg
injection, 20 mg/ml in 5-ml ampoule
fluorouracil (2)
levamisole (2)
mercaptopurine (2)
methotrexate (2)
injection, 50 mg/ml
in 5-ml ampoule
tablet, 50 mg
(as hydrochloride)
tablet, 2.5 mg (as sodium salt)
procarbazine
capsule, 50 mg (as hydrochloride)
vinblastine (2)
powder for injection,
10 mg (sulfate) in vial
vincristine (2)
powder for injection,
1 mg, 5 mg (sulfate) in vial
ferrous salt + folic acid
(nutritional supplement for use
during pregnancy)
tablet, equivalent
to 60 mg iron +
400 pg folic acid
folic acid (2)
tablet, 1 mg, 5 mg
injection, 1 mg (as sodium salt)
in 1-ml ampoule
hydroxocobalamin (2)
injection, 1 mg
in 1-ml ampoule
Complementary drug
“iron dextran (B) (5)
injection, equivalent to 50 mg
iron/ ml in 2-ml ampoule
10.2 DRUGS AFFECTING COAGULATION
desmopressin (8)
injection, 4 pg (acetate)Zml
in 1-ml ampoule
nasal spray, 10 pg (acetate)/
metered dose
heparin sodium
injection, 1000 lU/ml,
5000 lU/ml, 20 000 lU/ml
in 1-ml ampoule
powder for injection, 20 mg,
25 mg (as sodium phosphate or
sodium succinate) in vial
phytomenadione
injection, 10 mg/ml
in 5-ml ampoule
tablet, 10 mg, 20 mg (as citrate)
protamine sulfate
injection, 10 mg/ml
in 5-ml ampoule
8.3 HORMONES AND ANTIHORMONES
tamoxifen
tablet, equivalent to 60 mg iron
oral solution, equivalent to
25 mg iron (as sulfate)/ml
tablet, 50 mg
powder for injection, 50 mg
(as sodium salt) in vial
"prednisolone
ferrous salt
tablet, 5 mg
tablet, 10 mg
8.4 DRUGS USED IN PALLIATIVE CARE
“warfarin (2, 6)
The WHO Expert Committee on Essential Drugs recom
mended that all the drugs mentioned in the WHO publi
cation Cancer Pain Relief: with a Guide to Opioid Avail
ability, 2nd edition, be considered essential. The drugs
are included in the relevant sections of the model list
according to their therapeutic use, e.g. analgesics.
tablet, 1 mg, 2 mg and 5 mg
(sodium salt)
“ Example of a therapeutic group. Various drugs can serve as alternatives.
255
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
Section 11: Blood Products and
Plasma Substitutes
11.1
tablet, 250 mg,
500 mg (hydrochloride)
“procainamide (B)
injection, 100 mg
(hydrochloride)/ml
in 10-ml ampoule
PLASMA SUBSTITUTES
“dextran 70
injectable solution, 6%
“polygeline
injectable solution, 3.5%
tablet, 200 mg (sulfate)
“quinidine (A) (7)
12.3 ANTIHYPERTENSIVE DRUGS
11.2 PLASMA FRACTIONS FOR SPECIFIC USE
Complementary drugs
“factor VIII concentrate (C) (2, 8)
dried
“factor IX complex (coagulation
factors II, VII, IX, X) concentrate (C) (2, 8)
dried
tablet, 50 mg, 100 mg
“atenolol
“captopril
scored tablet, 25 mg
“hydralazine
tablet, 25 mg, 50 mg
(hydrochloride)
powder for injection, 20 mg
(hydrochloride) in ampoule
Section 12: Cardiovascular Drugs
"hydrochlorothiazide
12.1 ANTIANGINAL DRUGS
methyldopa (7)
tablet, 250 mg
“nifedipine (10)
sustained-release formulations
"atenolol
glyceryl trinitrate
“isosorbide dinitrate
“verapamil (10)
tablet, 50 mg, 100 mg
tablet (sublingual), 5 mg
tablet, 40 mg, 80 mg
(hydrochloride)
12.2 ANTIARRHYTHMIC DRUGS
tablet, 50 mg, 100 mg
digoxin (4, 11)
tablet, 62.5 pg, 250 pg
oral solution, 50 pg/ml
injection, 250 pg/ml
in 2-ml ampoule
verapamil (8, 10)
tablet, 10 mg
tablet (sublingual), 500 pg
“atenolol
lidocaine
scored tablet, 25 mg
injection, 1 mg in 1-ml ampoule
Complementary drugs
injection, 2.5 mg
(hydrochloride)/ml
in 2-ml ampoule
tablet, 500 pg, 1 mg (mesilate)
prazosin
“sodium nitroprusside
(C) (2, 8)
scored tablet, 25 mg
tablet, 62.5 pg, 250 pg
digoxin (4, 11)
oral solution, 50 pg/ml
injection, 250 pg/ml in 2-ml ampoule
dopamine
“hydrochlorothiazide
epinephrine (C)
injection, 1 mg
(as hydrochloride)/ml
isoprenaline (C)
injection, 20 pg
(hydrochloride)/ml
injection, 40 mg
(hydrochloride)/ml in 5-ml vial
tablet, 25 mg, 50 mg
12.5 ANTITHROMBOTIC DRUGS
acetylsalicylic acid
Complementary drugs
powder for infusion,
50 mg in ampoule
12.4 DRUGS USED IN HEART FAILURE
“captopril
injection, 20 mg
(hydrochloride)/ml
in 5-ml ampoule
tablet, 40 mg,
80 mg (hydrochloride)
tablet, 100 pg, 250 pg
"reserpine
tablet, 100 mg
Complementary drug
streptokinase (C)
powder for injection,
100 000 IU, 750 000 IU in vial
“ Example of a therapeutic group. Various drugs can serve as alternatives.
’All plasma fractions should comply with the Requirements forthe Collection, Processing and Quality Control of Blood, Blood
Components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840, 1994, Annex 2.
256
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WHO Drug Information Vol. 13, No. 4, 1999
12.6 LIPID-LOWERING AGENTS
13.4
The WHO Expert Committee on Essential Drugs recog
nizes the value oflipid-lowering drugs in treating patients
with hyperlipidaemia. Beta-hydroxy-beta-methylglutarylcoenzyme A (HMG CoA) reductase inhibitors, often re
ferred to as "statins", are potent and effective lipidlowering drugs with a good tolerability profile. Several of
these drugs have been shown to reduce the incidence of
fatal and non-fatal myocardial infarction, stroke and mor
tality (all causes), as well as the need for coronary by
pass surgery. All remain very costly but may be costeffective for secondary prevention of cardiovascular dis
ease as well as for primary prevention in some very highrisk patients. Since no single drug has been shown to be
significantly more effective or less expensive than others
in the group, none is included in the model list; the choice
of drug for use in patients at highest risk should be
decided at national level.
aluminium diacetate
Section 13:
Dermatological Drugs (topical)
13.1
lotion or cream, 5%
benzoyl peroxide
coal tar
solution, 5%
dithranol
ointment, 0.1-2%
ointment, 5%
fluorouracil
solution, 10-25%
“podophyllum resin (7)
solution 5%
salicylic acid
ointment or cream, 10%
urea
13.6
SCABICIDES AND PEDICULICIDES
“benzyl benzoate
lotion, 25%
permethrin
cream, 5%
lotion, 1%
ULTRAVIOLET-BLOCKING AGENTS
Complementary drugs
ointment or
cream, 6% + 3%
topical sun protection agent with
activity against UVA and UVB (C) cream, lotion or gel
ointment or cream, 2% (nitrate)
solution, 15%
sodium thiosulfate
Complementary drug
Section 14: Diagnostic Agents
14.1
selenium sulfide (C)
13.2
solution, 13% for dilution
DRUGS AFFECTING SKIN
DIFFERENTIATION AND PROLIFERATION
13.7
ANTIFUNGAL DRUGS
benzoic acid + salicylic acid
"miconazole
13.5
ASTRINGENT DRUGS
detergent-based
suspension, 2%
OPHTHALMIC DRUGS
eye drops, 1% (sodium salt)
fluorescein
eye drops, 0.5%
“tropicamide
ANTI-INFECTIVE DRUGS
14.2
RADIOCONTRAST MEDIA
"methylrosanilinium chloride
(gentian violet)
aqueous solution, 0.5%
tincture, 0.5%
“amidotrizoate
neomycin + “bacitracin (7)
ointment, 5 mg
neomycin sulfate
+ 500 III bacitracin zinc/g
injection, 140-420 mg iodine
(as sodium or meglumine
salt)/ml in 20-ml ampoule
barium sulfate
aqueous suspension
potassium permanganate
aqueous solution, 1:10 000
silver sulfadiazine
13.3
injection, 140-350 mg iodine/ml
in 5-ml, 10-ml and 20-ml ampoule
"iopanoic acid
ANTI-INFLAMMA TORY AND
ANTIPRURITIC DRUGS
"betamethasone (3)
'iohexol
cream, 1%, in 500-g container
ointment or cream,
0.1% (as valerate)
“calamine lotion
lotion
“hydrocortisone
ointment or cream, 1% (acetate)
"propyliodone
(For administration only into
the bronchial tree).
tablet, 500 mg
oily suspension,
500-600 mg/ml
in 20-ml ampoule
Complementary drug
"meglumine iotroxate (C)
solution, 5 - 8 g iodine
in 100-250 ml
“ Example of a therapeutic group. Various drugs can serve as alternatives.
257
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
Section 15:
Disinfectants and Antiseptics
17.2
ANTIEMETIC DRUGS
tablet, 10 mg (hydrochloride)
metoclopramide
injection, 5 mg (hydrochloride)/ml
in 2-ml ampoule
ANTISEPTICS
15.1
solution, 5%
(digluconate) for dilution
“chlorhexidine
elixir or syrup, 5 mg
(hydrochloride)/5 ml
solution, 70% (denatured)
“ethanol
“polyvidone iodine
solution, 10%
injection, 25 mg (hydrochloride)/ml
in 2-ml ampoule
DISINFECTANTS
15.2
tablet, 10 mg,
25 mg (hydrochloride)
“promethazine
“chlorine base compound
powder (0.1 % available
chlorine) for solution
solution, 4.8%
“chloroxylenol
solution, 2%
glutaral
“furosemide
ANTIHAEMORRHOIDAL DRUGS
17.4
ointment
or suppository
ANTI-INFLAMMATORY DRUGS
hydrocortisone
Section 16: Diuretics
“amiloride (4, 7, 8)
17.3
“local anaesthetic, astringent
and anti-inflammatory drug
suppository, 25 mg
(acetate)
“ retention enema
tablet, 5 mg (hydrochloride)
tablet, 40 mg
tablet, 500 mg
“sulfasalazine (2)
suppository, 500 mg
injection, 10 mg/ml in
2-ml ampoule
“hydrochlorothiazide
spironolactone (8)
tablet, 25 mg, 50 mg
tablet, 25 mg
retention enema
17.5
ANTISPASMODIC DRUGS
“atropine
tablet, 0.6 mg (sulfate)
injection, 1 mg (sulfate)
in 1-ml ampoule
Complementary drug
“mannitol (C)
injectable solution, 10%, 20%
17.6
Section 17: Gastrointestinal Drugs
17.1
ANTACIDS AND OTHER ANTIULCER
DRUGS
aluminium hydroxide
tablet, 500 mg
oral suspension, 320 mg/5 ml
“cimetidine
tablet, 200 mg
injection, 200 mg in 2-ml ampoule
magnesium hydroxide
oral suspension,
equivalent to 550 mg
magnesium oxide/10 ml
LAXATIVES
tablet, 7.5 mg (sennosides)
(or traditional dosage forms)
“senna
17.7
DRUGS USED IN DIARRHOEA
17.7.1
ORAL REHYDRATION
oral rehydration salts (for glucoseelectrolyte solution)
Components
sodium chloride
trisodium citrate dihydrate 2
potassium chloride
glucose
powder, 27.9 g/l
g/i
3.5
2.9
1.5
20.0
“ Example of a therapeutic group. Various drugs can serve as alternatives.
2Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5 g/l. However, as the
stability of this latter formulation is very poor under tropical conditions, it is only recommended when manufactured for
immediate use.
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WHO Drug Information Vol. 13, No. 4, 1999
17.7.2 ANTIDIARRHOEAL (SYMPTOMATIC)
DRUGS
"codeine (1a)
tablet, 30 mg (phosphate)
Section 18: Hormones, other Endo
crine Drugs and Contraceptives
18.1 ADRENAL HORMONES AND
SYNTHETIC SUBSTITUTES
diaphragms with spermicide
(nonoxinol)
18.4 ESTROGENS
injection, 4 mg dexamethasone
phosphate (as disodium salt)
in 1-ml ampoule
hydrocortisone
powder for injection, 100 mg
(as sodium succinate) in vial
"prednisolone
tablet, 1 mg, 5 mg
18.5 INSULINSAND OTHER ANTIDIABETIC
AGENTS
insulin injection (soluble)
injection,
40 lU/ml in 10-ml vial,
100IU/ml in 10-ml vial
(as compound insulin zinc suspension
or isophane insulin)
metformin
Complementary drug
testosterone (C) (2)
injection, 200 mg
(enantate) in 1-ml ampoule
“clomifene (2, 8)
tablet, 50 mg (citrate)
18.7 PROGESTOGENS
18.3 CONTRACEPTIVES
"ethinylestradiol +
"levonorgestrel
tablet, 30 pg + 150 pg,
“ethinylestradiol +
"levonorgestrel
tablet, 50 pg
+ 250 pg (pack of four)
"ethinylestradiol +
"norethisterone
tablet, 35 pg + 1.0 mg
tablet, 5 mg
norethisterone
Complementary drug
tablet, 5 mg
medroxyprogesterone acetate (B)
tablet, 0.75 mg (pack of two)
Complementary drugs
18.8 THYROID HORMONES AND
ANTITHYROID DRUGS
levothyroxine
tablet, 50 pg, 100 pg
(sodium salt)
potassium iodide
tablet, 60 mg
"propylthiouracil
tablet, 50 mg
tablet, 30 pg
"levonorgestrel (B)
medroxyprogesterone
acetate (B) (7, 8)
tablet, 500 m (hydrochloride)
18.6 OVULATION INDUCERS
18.3.1 HORMONAL CONTRACEPTIVES
levonorgestrel
injection,
40 lU/ml in 10-ml vial,
100 lU/ml in 10-ml vial
intermediate-acting insulin
tablet, 100 pg (acetate)
18.2 ANDROGENS
tablet, 2.5 mg, 5 mg
"glibenclamide
Complementary drug
fludrocortisone (C)
tablet, 10 pg, 50 pg
"ethinylestradiol
tablet, 500 pg, 4 mg
"dexamethasone
18.3.3 BARRIER METHODS
condoms with or without spermicide
(nonoxinol)
depot injection,
150 mg in 1-ml vial
Section 19: Immunologicals
19.1 DIAGNOSTIC AGENTS
norethisterone
enantate (B) (7, 8)
oily solution, 200 mg/ml in
1-ml ampoule
tuberculin,3
purified protein derivative (PPD)
injection
18.3.2 INTRAUTERINE DEVICES
copper-containing device
" Example of a therapeutic group. Various drugs can serve as alternatives.
3 All tuberculins should comply with the Requirements for Tuberculins (Revised 1985). WHO Technical Report Series, No.
745, 1987, Annex 1.
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WHO Drug Information Vol. 13, No. 4,1999
Essential Drugs
19.2
SERA AND IMMUNOGLOBULINS4
anti-D immunoglobulin
(human)
“antitetanus immunoglobulin
(human)
antivenom serum
diphtheria antitoxin
injection, 250 pg in
single-dose vial
injection, 500 III
in vial
injection, 5 mg/ml
in 2-ml ampoule
“alcuronium chloride (2)
injection
injection, 10 000 IU,
20 000 IU in vial
immunoglobulin,
human normal (2)
injection (intramuscular)
immunoglobulin,
human normal (2, 8)
injection (intravenous)
“rabies immunoglobulin
injection, 150 lU/ml
19.3
Section 20:
Muscle Relaxants (peripherally act
ing) and Cholinesterase Inhibitors
tablet, 15 mg (bromide)
"neostigmine
injection, 500 pg, 2.5 mg
(metilsulfate) in 1-ml ampoule
tablet, 60 mg
pyridostigmine bromide (2, 8)
injection, 1 mg
in 1-ml ampoule
injection, 50 mg/ml
in 2-ml ampoule
suxamethonium
chloride (2)
VACCINES5
19.3.1
FOR UNIVERSAL IMMUNIZATION
BCG
powder for injection
Complementary drug
powder for injection,
10 mg in vial
vecuronium bromide (C)
diphtheria
pertussis
tetanus
Section 21:
Ophthalmological Preparations
hepatitis B
27.7 ANTI-INFECTIVE AGENTS
measles
"gentamicin
solution (eye drops), 0.3%
(as sulfate)
"idoxuridine
solution (eye drops), 0.1 %
influenza
silver nitrate
solution (eye drops), 1%
meningitis
"tetracycline
eye ointment, 1 % (hydrochloride)
poliomyelitis
19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS
eye ointment, 0.2%
mumps
27.2 ANTI-INFLAMMATORY AGENTS
rabies
"prednisolone
rubella
solution (eye drops), 0.5%
(sodium phosphate)
typhoid
27.3 LOCAL ANAESTHETICS
yellow fever
“tetracaine
solution (eye drops), 0.5%
(hydrochloride)
27.4 MIOTICS AND ANTIGLAUCOMA DRUGS
acetazolamide
tablet, 250 mg
“ Example of a therapeutic group. Various drugs can serve as alternatives.
4 All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood,
Blood components and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840,1994, Annex 2.
5 All vaccines should comply with current WHO recommendations for biological substances.
260
Essential Drugs
WHO Drug Information Vol. 13, No. 4, 1999
solution (eye drops), 2%, 4%
(hydrochloride or nitrate)
“pilocarpine
solution (eye drops), 0.25%, 0.5%
(as maleate)
“timolol
24.2
DRUGS USED IN MOOD DISORDERS
24.2.1
DRUGS USED IN DEPRESSIVE
DISORDERS
tablet, 25 mg (hydrochloride)
“amitriptyline
21.5 MYDRIATICS
atropine
solution (eye drops),
0.1%, 0.5%, 1% (sulfate)
Complementary drug
Section 22:
Oxytocics and Antioxytocics
OXYTOCICS
“ergometrine (1c)
valproic acid (7, 11)
24.3
DRUGS USED IN GENERALIZED
ANXIETY AND SLEEP DISORDERS
scored tablet, 2 mg, 5 mg
“diazepam (1b)
tablet, 200 pg (hydrogen maleate)
ANTIOXYTOCICS
tablet, 4 mg (as sulfate)
“salbutamol (2)
injection, 50 pg (as sulfate)/ml
in 5-ml ampoule
DRUGS USED IN OBSESSIVE
COMPULSIVE DISORDERS AND
PANIC ATTACKS
clomipramine
capsules, 10 mg, 25 mg
(hydrochloride)
intraperitoneal dialysis solution
(of appropriate composition)
Section 25: Drugs Acting on
the Respiratory Tract
25.1
ANTIASTHMATIC DRUGS
injection, 25 mg/ml
in 10-ml ampoule
“aminophylline (2)
Section 23: Peritoneal
Dialysis Solution
inhalation (aerosol), 50 pg, 250 pg,
(dipropionate) per dose
“beclometasone
parenteral solution
Section 24:
Psychotherapeutic Drugs
"epinephrine
injection, 1 mg (as hydrochloride
or hydrogen tartrate) in 1-ml ampoule
ipratropium bromide
“fiuphenazine (5)
“haloperidol
inhalation (aerosol), 20 pg/dose
tablet, 2 mg, 4 mg (as sulfate)
"salbutamol
inhalation (aerosol), 100 pg
(as sulfate) per dose
DRUGS USED IN PSYCHOTIC DISORDERS
“chlorpromazine
capsule or tablet, 300 mg
enteric coated tablet,
200 mg, 500 mg (sodium salt)
injection, 10 IU in 1-ml ampoule
oxytocin
24.1
carbamazepine (10, 11) scored tablet, 100 mg, 200 mg
24.4
injection, 200 pg (hydrogen maleate)
in 1-ml ampoule
22.2
DRUGS USED IN BIPOLAR DISORDERS
lithium carbonate (2, 4)
solution (eye drops), 2%
(as hydrochloride)
epinephrine (A)
22.1
24.2.2
tablet, 100 mg (hydrochloride)
syrup, 2 mg (as sulfate)/5 ml
syrup, 25 mg
(hydrochloride)/5 ml
injection, 50 pg (as sulfate)/ml
in 5-ml ampoule
injection, 25 mg
(hydrochloride)/ml in 2-ml ampoule
respirator solution for use in nebulizers,
5 mg (as sulfate)/ml
injection, 25 mg
(decanoate or enantate)
in 1-ml ampoule
theophylline (10, 11)
tablet, 2 mg, 5 mg
“cromoglicic acid (B)
injection, 5 mg in
1-ml ampoule
“ Example of a therapeutic group. Various drugs can serve
tablet, 100 mg, 200 mg, 300 mg
Complementary drug
inhalation (aerosol),
20 mg (sodium salt) per dose
; alternatives.
261
WHO Drug Information Vol. 13, No. 4, 1999
Essential Drugs
26.3
25.2 ANTITUSSIVES
oral solution,
3.5 mg (bromide)/5 ml
“dextromethorphan
Section 26:
Solutions correcting Water, Electrolyte and Acid- base Disturbances
MISCELLANEOUS
2-ml, 5-ml, 10-ml ampoules
water for injection
Section 27: Vitamins and Minerals
ascorbic acid
tablet, 50 mg
"ergocalciferol
capsule or tablet, 1.25 mg
(50 000 IU)
oral solution,
250 pg/ml (10 000 IU/ml)
26.7 ORAL
oral rehydration salts (for glucoseelectrolyte solution)
for composition
see section 17.7.1
potassium chloride
powder for solution
iodine (8)
solution, 0.57 ml, (308 mg iodine)
in dispenser bottle
26.2 PARENTERAL
glucose
injectable solution,
5% isotonic, 10% isotonic,
50% hypertonic
glucose with
sodium chloride
injectable solution, 4%
glucose, 0.18% sodium chloride
(equivalent to Na
*
30 mmol/l
Cl- 30 mmol/l)
potassium chloride (2)
11.2% solution in
20-ml ampoule, (equivalent to
* 1.5 mmol/ml, Ch 1.5 mmol/ml)
K
sodium chloride
injectable solution, 0.9%
isotonic (equivalent to Na
*
154
mmol/l, Cl-154 mmol/l)
sodium hydrogen
carbonate
injectable solution, 1.4%
isotonic (equivalent to Na
*
167
mmol/l, HCO3- 167 mmol/l)
8.4% solution in 10-ml ampoule
(equivalent to Na
*
1000 mmol/l,
HC03-1000 mmol/l)
“ compound solution of
sodium lactate
iodized oil, 1 ml (480 mg iodine),
0.5 ml (240 mg iodine) in
ampoule (oral or injectable)
injectable solution
capsule, 200 mg
tablet, 50 mg
"nicotinamide
pyridoxine
“retinol
tablet, 25 mg (hydrochloride)
sugar-coated tablet, 10 000 III
(as palmitate) (5.5 mg)
capsule, 200 000 IU (as
palmitate) (110 mg)
oral oily solution,
100 000 IU/ml in multidose
dispenser (as palmitate)
water-miscible injection,
100 000 IU (as palmitate)
(55 mg) in 2-ml ampoule
tablet, 5 mg
riboflavin
“sodium fluoride
in any appropriate formulation
thiamine
tablet, 50 mg (hydrochloride)
Complementary drug
calcium gluconate (C) (2, 8)
injection,100 mg/ml
in 10-ml ampoule
“ Example of a therapeutic group. Various drugs can serve as alternatives.
The following changes in the WHO Model List were approved by the WHO Expert Committee on
the Use of Essential Drugs which met in December 1999. The report of the meeting will be
published in the WHO Technical Report Series.
Deletions:, albumin (human); antiscorpion sera.
Additions: acetylcysteine; rifampicin + isoniazid + pyrazinamide + ethambutol; nevirapine; artesunate;
chlorambucil; daunorubicin; ethanol; iohexol.
Replacements: fluconazole to replace ketoconazole; prazosin to replace doxazosin.
262
The Hindu : Kerala News : Kerala model of healthcare in peril, says Ekbal
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'The poor may find it difficult to meet the medical
expenses.'
THiRUVANANTHAPURAM: The former Kerala University vicechancellor, B. Ekbal, has said that the "good health at low
cost" Kerala model of healthcare based on social justice and
equity is in danger of being dismantled following the
switchover from process patency to product patency regime.
Features:
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Magazine
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Speaking on 'Indian Patent Laws Changes and the Medical
Profession' at the 13th State annual conference of the
Qualified Private Medical Practitioners' Assocation (QPMPA)
here on Saturday, Dr. Ekbal said the poor and the middle
class were going to find it extremely difficult to meet the
jLjb
http://www.hinduonnet. com/2005/04/24/stories/2005042407670400.htm
4/25/2005
ne .iinau : rs-eraia News : Kerala model or Tk .utncare in pen , says nKoa
age x. u*
healthcare expenses in the very near future on account of
the changes in the patency regime. Under the product
patency regime in existence in the country since 1970,
Indian companies could make cheap drugs through different
processes for the drugs patented in other countries.
However, hereafter, this would not be possible and all new
drugs patented would be priced very high. Since majority of
the people in Kerala utilised modern medicines, the high
drug prices would hit Keralites more than the people in other
States, he said.
Role of doctors
Dr. Ekbal, who is also the national convener of the People's
Health Movement, said the medical profession has a major
role to play in the changed context. The medical
practitioners can, for instance, help the people a lot by
prescribing only the necessary essential drugs and avoiding
non-essential drugs. For this, the doctors should first
become drug price conscious. They should also select good
quality cheap drugs that are available in the market instead
of costly drugs marketed by big multinational companies. At
present, the same class of drugs are marketed by different
companies at different prices. For example, in the case of
Atenolol, a drug commonly used for management of heart
diseases, the lowest priced good quality drug marketed by
an Indian company, is priced at 40 paise a tablet whereas
the price of the widely prescribed brand of a multinational
company is Rs. 2.30 a tablet.
Similarly, in the case of Cetrizine, a drug for the
management of allergic conditions, the prices at the low end
and the high end were 30 paise and Rs. 3.15 a tablet.
Besides being price conscious, doctors should avoid
prescribing drugs of dubious therapeutic benefits, irrational
combination drugs and drugs banned in other countries, he
said. Drug companies are spending about 40 per cent of
their sales turnover for drug promotion, mostly targeting
doctors.
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http://www.hinduonnet.corn/2005/04/24/stories/2005042407670400.htm
4/25/2005
New York Times EDITORIAL
April 21. 2005
Time to Ban Ephedra
he recent disappointing federal court decision that the Food and Drug Administration
lacks the authority to issue a blanket ban on ephedra, a dangerous herbal supplement, is a
clarion call to the Bush administration and Congress to change the 1994 law on dietary
supplements. The law should be amended to give health regulators clear and
unambiguous power to take harmful products off the market, and to require supplement
makers to report any adverse reactions.
Ephedra, an adrenalinelike stimulant promoted as a weight-loss aid and energy booster,
excites the central nervous system and speeds metabolism, increasing the rate at which a
person bums calories. But it can also drive up blood pressure and stress the circulatory
system. It has been linked to heart attacks and strokes and dozens of deaths.
A year ago, the F.D.A. imposed a ban on all products containing ephedra on the grounds
that it poses "an unreasonable risk of illness or injury." Overturning that decision, Judge
Tena Campbell of the Federal District Court in Utah said the agency had erred in using a
cost-benefit analysis, weighing the supplement's substantial risks against its dubious
benefits. The judge also said that the 1994 law required dose-specific findings to justify a
ban. The judge concluded that the agency's assertion that it was impossible to establish a
level of safe use failed to meet the burden of proving that the supplement poses an
unreasonable risk when taken in the 10-milligram doses contained in the product at issue.
The ruling leaves the ephedra ban intact for products containing doses above 10
milligrams. But by dismissing the F.D.A.'s voluminous evidence of potential danger, the
court set an unrealistically high threshold for agency action, and that could undermine the
ban even for higher-dose ephedra products.
Under current law, supplement manufacturers may sell products without first having to
establish their safety or efficacy. But after the F.D.A. found a significant hazard, it was
only reasonable for the agency to weigh ephedra's lack of any real health benefits in
deciding on a regulatory response.
The agency should appeal, but the White House and Congress should not let the F.D.A.
do all the heavy lifting. The decision is their cue to move promptly to enact overdue legal
revisions that will significantly strengthen the agency's power to monitor and police the
supplement industry.
Essential Medicines for the Elderly
Delhi Society for
Promotion of Rational
Use of Drugs
and
HelpAge India
III®
‘Essential Medicines for the 'Elderly
Delhi Society for Promotion
of Rational Use of Drugs
and
HelpAge India
Foreword
It has not yet been clearly understood that the drugs to be administered
to the elderly need careful deliberation before use. There are several
reasons for this. The metabolic processes which inactivate a drug become
less in the elderly. This means that a reduced quantity of the medicine
should be adequate and there may be no need for the higher dose, which
needs to be given to a person at the age of 35 or 40 years. Indeed the
dose given to the elderly may, for many drugs, induce serious side effects
because of the high level of these medicines in the blood.
Elderly people usually need more drugs as they get old. The danger
of interaction between drugs increases as the number of drugs being taken
are enhanced. Physicians, when prescribing a large number of medicines
to the elderly, need to consider carefully, whether any of the medicines
being taken at the same time could induce interactions.
It is no wonder therefore that a WHO Technical Report has
stated that half of the total drug consumption is by people aged 60 years
and over in those countries where the proportion of this age group is
high. India is a country where there will be a very large proportion of
aged people in the next twenty years. The numbei of medicines which
would be used would be very high. Unless propel doses are used and a
programme of rational use of drugs for the elderly set up theie would be
misuse of the medicines. A WHO group has pointed out
that one fifth of patients entering the geriatric department of a general
hospital have symptoms, which can be attributed to the effect of prescribed
drugs.
The purpose of this publication is to list those drugs which are suitable
for the elderly. An expert group from the Delhi Society for Promotion of
Rational Use of Drugs and HelpAge India have prepared this list. This
has been further reviewed by other experts. It is hoped that clinicians
and hospitals looking after elderly persons would use this information
which would lead to optimal use of medicines in the elderly.
The
formulation and strength of the medicines to be used has also been
provided. If used properly medicines could be a boon to the elderly patient.
Used inappropriately and irrationally medicines could be hazardous for
the elderly.
This list is only one component of a collaborative endeavour of the
Delhi Society for Promotion of Rational Use of Drugs and HelpAge India.
Such a complementary effort would be of great benefit to the elderly.
New Delhi
17th March, 2003
Professor Ranjit Roy Chaudhury,
President, Delhi Society for
Promotion of Rational Use of Drugs.
PREFACE
In India, today, there are more than 60 million elderly people who are unable to
reach basic medical aid. HelpAge India’s Mobile Medicare Unit (MMU) Programme
enables older people to assume an active role in maintaining and improving their
health. These MMUs visit the assigned area the same day week after week to give
medical care to older persons. About 50 MMUs are at present serving thousands of
older persons residing in slums, resettlement colonies and adjoining rural areas
providing medicines, counselling and health care free of cost.
As the joint initiative of the Delhi Society for Promotion of Rational Use of Drugs
under the INDIA- WHO Essential Drugs Programme and Helpage India, one of the
important steps identified for this purpose was to prepare an Essential Medicines
List for the elderly. Eight experts met and prepared this list in July 2002. The Essential
Drugs List implies that drugs included in it are adequate to meet the common
contemporary health needs of the elderly population, and health administrators should
ensure abundant availability of such drugs. The exclusion of any medicines in the
List, which is currently available and recommended by physicians, does not imply
that they are less effective or unsuitable for the patients. Their exclusion may have
been influenced by one or more of the following factors: cost-benefit ratio indicated
in the treatment of diseases not considered significant in the context, insufficient
experience with the drug in India.
The List is meant to be used as a guideline to the concept of rational therapeutics.
The medicines selected are considered adequate to treat diseases commonly
encountered in the outpatient department at the mobile health units by HelpAge
India. The List is intended to be a dynamic document, subject to change, with
addition and/or deletion, as medical knowledge advances and new drugs become
available at remunerative prices. The list uses generic names for scientific clarity.
(Sangeeta Sharma)
Assistant Professor, Deptt. of Neuropsychopharmacology
Institute of Human Behaviour & Allied Sciences and
Technical Coordinator, India-WHO Essential Drugs Programme
List of Contributors
Professor Ranjit Roy Chaudhury
Air Marshall Vinod Patney (Retd.)
President
Delhi Society for Promotion of
Rational Use of Drugs
New Delhi
Director General
HelpAge India
New Delhi
Dr. Sangeeta Sharma
Col. A. Sharma (Retd.)
Assistant Professor, Dept, of
Neuropsychopharmacology
Institute of Human Behaviour &
Allied Sciences and
Technical Coordinator, India-WHO
Essential Drugs Programme
Head, Mobile Medicare Unit
HelpaAge India
New Delhi
Prof. Gopal Sachdev
Dr. Karmakar
Professor, Department of Medicine
Maulana Azad Medical College
New Delhi
Consultant Physician, Mobile
Medicare Unit
HelpaAge India
New Delhi
Col. V.P. Chaturvedi
Dr. Shubha Soneja
Head, Department of Rheumatology
Army Hospital (R&R), New Delhi
Head, Research & Development and
Convenor
Help Age India
New Delhi
THE ESSENTIAL MEDICINES CONCEPT
Effective health care requires a judicious balance of preventive and curative services.
A crucial and often deficient element in curative services is an adequate supply of
appropriate medicines. The health objectives of the Drug Policy is:
• To ensure the availability and accessibility of essential drugs to all citizens
• To ensure good prescribing and dispensing practice
• To promote the rational use of drugs by prescribers, dispensers and patients
through provision of the necessary training, education and information
Achieving these objectives requires a comprehensive strategy that not only includes
improved supply and distribution, but also appropriate and extensive human resource
development. The criteria for the selection of essential medicines include the following
points:
• Any drug included must meet the needs of the majority of the population
• Sufficient proven scientific data regarding effectiveness must be available
• Any drug included in the EML
• should have substantial safety and benefit/risk ratio
• All products must be of an acceptable quality, and must be tested on a continuous
basis
• The aim, as a rule, is to include only products containing single pharmacologically
active ingredients
• Combination products, as an exception, will be included where patient compliance
becomes an important factor, or two pharmacologically active ingredients are
synergistically active in a product
• Products are listed according to their generic names only
• Where drugs are clinically equally effective, the drugs are compared on the
following factors:
■ The best cost advantage
■ The best researched
■ The best pharmacokinetic properties
■ The best patient compliance
A request for a new product to be included in the EDL must be supported by scientific
evidence-based data and appropriate references on its advantages and benefits over
an existing product.
Essential drugs are those that satisfy the priority needs of the
population. They should, therefore, be available at all times, in
adequate amounts, and in the appropriate dosage forms.
ESSENTIAL MEDICINES LIST
FOR THE ELDERLY
List of contents
S.No.
1
Category
Page
No.
The essentia! medicines concept
i
Analgesics & Antipyretics
1
Ibuprofen, Dextropropoxyphen, Paracetamol,
Dicyclomine, Roficoxib
2
Antacids
1
Omeprazole, Ranitidine, Aluminium
hydroxide/silicate/carbonate+Magnesium
hydroxide/carbonate/trisilicate +Methyl Polysiloxane
(Dimethicone)
3
Antiameobic
1
Tinidazole
4
Antibiotics
1
Amoxycillin, Ciprofloxacin, Co-trimoxazole,
Doxycycline, Norfloxacin, Roxithromycin, Ofloxacin
5
Antiemetics
2
Domperidone, Metoclopropamide, Prochlorperazine
6
Antifungal
Fluconazole, Griseofulvin
7
Antihelmintic
Albendozole, Pyrantel pamoate
8
Antihistamines
Cetrizine, Pheniramine maleate
2
2
2
9
Antihypertensives
2
Amlodipine, Atenolol, Enalapril, Lisinopril, Losartan,
Metoprolol, Nifedipine, Prazosin
10
Antimalarials
Chloroquine, Pyrimethamine (+Sulphadoxine),
2
Quinine
11
Anti-tubercular drugs
3
Ethambutol (E), Isonaizid (H), Pyrazinamide (Z),
Rifampicin (R), Fixed dose preparations
12
Antitussives, Cough syrups, Decongestants
3
Cough syrup
13
14
Bronchodilators
Budesonide, Ipratropium, Salbutamol, Theophyline-SR
3
Cardiovascular drugs
3
Acenocoumarol, Aspirin, Digoxin, Diltiazem, Isosorbide dinitrate,
Isosorbide mononitrate
15
Central Nervous System drugs + drugs for psychiatric illness
4
Carbamazepine, Phenytoin, Sodium valproate, Alprazolam,
Diazepam, Fluoxetine, Imipramine, Sertraline, Cinnarizine
16
Diuretics
4
Frusemide, Triameterene (+ Benzthiazide), Spiranolactone +
Frusemide
17
Hormone and anti-hormones
4
Carbimazole, L-Thyroxine, Glibenclamide, Gliclazide, Metformin,
Prednisolone
18
Laxative, Purgatives & Anti-diarrheals
Bisacodyl, Isapgol husk, Paraffin + milk of magnesia,
Sodium picosulphate, Loperamide
4
19
Nutritional supplements and vitamins
5
Calcium (carbonate) + Vitamin D2 , Folic Acid,
Ferrous sulphate/Ferros fumarate, Vitamin B Complex,
Vitamin C, Vitamin E, ORS Sachets
20
Topical Preparations
5
20.1
Analgesic
5
Diclofenac sodium
20.2 Antibiotic preparations
5
Povidone Iodine, Polymixin B, Soframycin
20.3
Antifungal preparations
5
Clotrimazole, Miconazole
20.4
Eye drops & Ointments^
6
Pillocarpine, Timolol, Sulphacetamide, Gentamicin, Ciprofloxacin,
Polymyxin B, Methyl Cellulose
20.5
ENT preparations
6
Oxymetazoline nasal drops, Ciprofloxacin ear drops, Gentamicin ear
drops, Wax softener
20.6
For Scabies
6
Benzyl Benzoate, Gamma benzene hexachloride
20.7
Miscellaneous items
Cotton packet, Diastix, Gauge and bandage, Glycerine, Cetrimide
6
Essential Medicines List for the Elderly
I Name & Class of the drug 1
1 Formulation & Strength 1
1. Analgesics & Antipyretics
Ibuprofen
Dextropropoxyphen3
Paracetamol3
Dicyclomine3
Roficoxib'
Tab 200mg, 400mg, 600mg
Cap 65mg
Tab 500mg, 1000mg
Tab 20mg
Tab 12.5mg, 25 mg
2. Antacids
Omeprazole'
Tab 20mg
Ranitidine'
Tab 150mg
Combinations of
Liquid, Tab
Aluminium hydroxide/silicate/carbonate
+Magnesium hydroxide/carbonate/trisilcate
+Methyl Polysiloxane (Dimethicone)
3.
Antiameobic
Tab 500mg, 1000mg
Tinidazole
4. Antibiotics
Cap 250mg, 500mg
Tab 250mg, 500mg
Tab (SMX 400mg+TMP80mg)
Tab (SMX 800mg+TMP160mg)
Cap 100mg
Tab 400mg
Tab 150mg
Tab 200mg
Amoxycillin
Ciprofloxacin3
Co-trimoxazole1
Doxycycline
Norfloxacin3
Roxithromycin3
Ofloxacin3
a
b
c
Contraindicated in renal dysfunction
Contraindicated in hepatic dysfunction
Contraindicated in both renal and hepatic dysfunction
d
e
f
Administer with caution in renal dysfunction
Adminstcr with caution in hepatic dysfunction
Administer with caution in renal and /or hepatic dysfunction
1
5. Antiemetics
Tab 10mg
Tab 10mg
Tab 5mg, 25mg
Domperidoned
Metoclopropamide
Prochlorperazine0
6. Antifungal
Cap 50mg, 100mg
Tab 125mg, 250mg
Fluconazoleb
Griseofulvinb
7. Antihelmintic
Tab 400mg
Tab 200mg, 250mg
Albendozole'
Pyrantel pamoateb
8. Antihistamines
Tab 10mg
Tab 25mg, 50mg
Cetrizined
Pheniramine maleate
9. Antihypertensives
Amlodipine6
Atenolold
Enalapril0
Lisinopril0
Losartan6
Metoprolol
Nifedipine
Prazosin
Tab 2.5mg, 5mg, 10mg
Tab 25mg, 50mg, 100mg
Tab 2.5mg, 5mg, 10mg
Tab 2.5mg, 5mg, 10mg
Tab 25mg, 50mg
Tab 50mg, 100mg
Tab 10mg, 20mg
Tab 1, 2mg, 5mg
10 . Antimalarials
Chloroquine0
Pyrimethamine+Sulphadoxine
Quinine'
a
b
c
d
e
f
Tab 250mg
Tab 25mg +500mg
Tab 300mg, 600mg
Contraindicated in renal dysfunction
Contraindicated in hepatic dysfunction
Contraindicated in both renal and hepatic dysfunction
Administer with caution in renal dysfunction
Adminster with caution in hepatic dysfunction
Administer with caution in renal and /or hepatic dysfunction
2
11. Anti-tubercular drugs'
12.
Ethambutol (E)
Isonaizid (H)
Pyrazinamide (Z)b
Rifampicin (R)
Tab 400mg, 600mg, 800mg
Tab 100mg, 300mg
Tab 500mg, 750mg
Cap 300mg, 450mg, 600mg
Fixed dose preparations
Rifampicin 450mg + Isoniazid 300mg
Rifampicin 600mg + Isoniazid 300mg
R450 + H300 + E800 + Z1500mg
R450 + H300 + E800
Cap/Tab
Cap/Tab
Kit
Kit
Antitussives, Cough syrups, Decongestants
Cough syrup with very small quantity of Codeine
and no pseudoephedrine)
13. Bronchodilators
MDI 100mcg, 200mcg
MD] 20mcg
MDI 200mcg
Tab 2mg, 4mg
Tab 300mg
Budesonide
Ipratropium
Salbutamol
Salbutamol
Theophyline-SRe
14. Cardiovascular drugs
Tab 1mg, 2mg, 4mg
Tab 100mg
Tab 0.25mg
Tab 30mg, 90mg (SR),
120mg (SR)
Tab 5mg
Tab 10mg, 20mg, 60mg (SR)
Acenocoumarol'
Aspirin'
Digoxin
Diltiazem’
Isosorbide dinitrate
Isosorbide mononitrate
a
b
c
Contraindicated in renal dysfunction
Contraindicated in hepatic dysfunction
Contraindicated in both renal and hepatic dysfunction
d
e
f
Administer with caution in renal dysfunction
Adminster with caution in hepatic dysfunction
Administer with caution in renal and /or hepatic dysfunction
3
15. Central Nervous System drugs + drugs for
psychiatric illness
Carbamazepine'
Phenytoin'
Sodium valproate”
Tab 200mg
Tab/Cap100mg, 300mg
Tab 200mg
Alprazolam
Diazepam'
Fluoxetine3,1
Imipramine'
Sertraline'
Cinnarizine
Tab 0.25mg, 0.5mg
Tab 5mg
Cap 20mg
Tab 25mg, 75mg
Tab, Cap 50mg, 100mg
Tab 25, 75mg
16. Diuretics
Frusemide
Triamterene ( + Benzthiazide 25mg)'
Spiranolactone + Frusemide3,6
Tab 40mg
Tab 50mg
Tab 50mg
17. Hormone and anti-hormones
Tab 5mg, 10mg
Tab 0.025mg, 0.05mg, 0.1mg
Tab 2.5mg, 5mg
Tab 80mg, 40mg
Tab 500mg, 850mg
Tab 5mg, 10mg, 20mg
Carbimazole
L-Thyroxine
Glibenclamide
Gliclazide0
Metformin
Prednisolone
18. Laxative, Purgatives &
Anti-diarrheals
Bisacodyl
Isapgol husk
Liquid paraffin + milk of magnesia
Sodium picosulphate
Loperamide
a
b
c
d
e
f
Contraindicated in renal dysfunction
Contraindicated in hepatic dysfunction
Contraindicated in both renal and hepatic dysfunction
Administer with caution in renal dysfunction
Adminster with caution in hepatic dysfunction
Administer with caution in renal and /or hepatic dysfunction
4
Tab 5mg
Powder
Liquid
Tab 10mg
Tab/Cap 2 mg
19.
Nutritional supplements and vitamins
Calcium (carbonate) + Vitamin D2
Tab 500mg
Folic Acid
Iron preparations
Tab 5mg
Ferrous sulphate
Ferros fumarate
(Any one of the above where
elemental Iron is = 60mg,
Tab/Cap 30mg/100mg
Tab/Cap 33.3mg/100mg
equivalent to 200mg)
Vitamin B Complex
Vitamin C
Vitamin E
ORS
20.
Tab, Cap
Tab 100mg, 500mg
Cap 200mg, 400mg
Sachets (WHO composition)
Topical Preparations
20.1 Analgesic
Oint. 1.16%
Diclofenac sodium
20.2 Antibiotic preparations
Oint, Sol 5%
Oint.
Oint
Povidone Iodine
Polymixin B
Soframycin
20.3 Antifungal preparations
1% cream
2% cream
Clotrimazole
Miconazole
a
b
c
d
e
f
Contraindicated in renal dysfunction
Contraindicated in hepatic dysfunction
Contraindicated in both renal and hepatic dysfunction
Administer with caution in renal dysfunction
Adminster with caution in hepatic dysfunction
Administer with caution in renal and /or hepatic dysfunction
5
20.4
Eye drops & Ointments
1%, 2%, 4%
0.25%, 0.5%
10%, 20%
0.3%
Eye drop and Oint
Eye drop and Oint
Eye drop and Oint
Pillocarpine
Timolol
Sulphacetamide
Gentamicin
Ciprofloxacin
Polymyxin B
Methyl Cellulose
20.5
ENT preparations
0.1% 3mg/ml
0.3%
Ear drops
Oxymetazoline nasal drops
Ciprofloxacin ear drops
Gentamicin ear drops
Wax softener
20.6
For Scabies
Benzyl Benzoate
Gamma benzene hexachloride
20.7
Miscellaneous items
Cotton packet
Diastix
Gauge and bandage
Glycerine
Cetrimide
6
Emulsion 25%
Lotion 1%
----- SOME OTHER PUBLICATIONS -----o
Delhi Drug Policy.
o
Delhi State Essential Drug Formulary.
o
List of Essential Drugs for Hospitals and Dispensaries in
Delhi and other States.
o
Promotion of Rational Use of Drugs in the Indian Scenario.
o
The Medicine Scenario in India: Perception and
Perspectives.
®
Research on Rational Drug Use in India : A Glimpse.
•
Standard Treatment Guidelines for Karnataka, Mumbai &
Himachal Pradesh.
o
HIV/AIDS and Traditional Medicines : A Journey to
Dialogue.
o
Standard Treatment Guidelines.
o
Use Your Medicines Correctly - A User’s Guide.
Delhi Society for Promotion of Rational Use of Drugs
(Registered under Societies Registration Act of 1860, Regd. No. S 30330 of 1996)
National Institute of Immunology
Aruna Asaf Ali Marg, New Delhi 110 067 Phone : 2616 2281, 2617 9638, Fax : 2616 2125
Website: www.dsprud.org
E-mail: dsprud@satyam.net.in
- Media
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