What are examples of essential medicines?

Essential Medicines: Core Examples and Categories

Essential medicines are the most effective, safe, and cost-efficient medications necessary for a functioning healthcare system, as defined by the WHO Model List of Essential Medicines (EML), which addresses priority healthcare needs of populations. 1

Definition and Core Concept

Essential medicines represent the minimum medicine needs for every health-care system, selected based on:

• Cost-effectiveness and ready availability 1
• Evidence-based efficacy for priority health conditions 1
• Safety profile and quality assurance 1

The concept emphasizes that using a limited number of well-known medicines leads to improved long-term supply, lower costs, and better healthcare provision. 2

Key Categories with Specific Examples

Antibiotics (AWaRe Classification)

The 2023 AWaRe classification provides empirical guidance on 41 essential antibiotics across three tiers: 1

Access Group (First-line, narrow-spectrum):

• Amoxicillin-clavulanic acid 1
• Cloxacillin/dicloxacillin 1
• Cefalexin 1
• Clindamycin 1
• Metronidazole 1

Watch Group (Second-line, broader-spectrum with resistance concerns):

• Ceftriaxone 1
• Piperacillin-tazobactam 1
• Vancomycin 1
• Levofloxacin and ciprofloxacin 1

Reserve Group (Last-resort options):

• Carbapenems 1
• Polymyxins 1

Targeted Cancer Therapies

The 22nd WHO EML includes immune-modulating and targeted therapies: 1

• Trastuzumab 1
• Imatinib 1
• Erlotinib, gefitinib, and afatinib 1
• Nivolumab and pembrolizumab 1

Critical Care Pharmaceuticals

For disaster preparedness and intensive care, essential pharmaceuticals include: 3

Life-sustaining medications:

• Anti-virals (especially neuraminidase inhibitors) 3
• Vasopressors 3
• Sedatives and analgesics 3
• Neuromuscular blocking agents 3
• Antibiotics 3

Supportive therapies:

• Bronchodilators 3
• Thromboembolism prophylaxis 3
• Gastrointestinal hemorrhage prophylaxis 3
• Fluids for resuscitation 3

Rheumatologic Disease Management

WHO recognizes as essential for joint diseases: 3

• Hydroxychloroquine 3
• Methotrexate 3
• Acetylsalicylic acid 3
• Triamcinolone acetonide or hexacetonide 3
• Biologics: adalimumab, etanercept, infliximab (including quality-assured biosimilars) 3

Pain and Palliative Care

• Ibuprofen 3
• Paracetamol 3

Implementation Principles

Availability requirements: Essential medicines should be accessible at all times to everyone within a functioning healthcare system, satisfying priority healthcare needs. 1

National adaptation: Countries should develop country-specific lists that: 1

• Consider local disease prevalence 1
• Account for antimicrobial resistance patterns 1
• Ensure therapeutic choices are consistent and cost-effective 1
• Enable national pricing negotiations for generic medicines 1

Global Access Disparities

High-income countries: Essential medicines are almost always available at no cost or subsidized, with formulary inclusion rates exceeding 90%. 1

Low-middle-income countries: Medicines are generally provided only at full out-of-pocket cost, with generic availability in the public sector ranging from 36.1% to 44.3%. 1

Barriers include: Financial constraints from high medication costs and supply chain issues such as inadequate stock and poor distribution. 1

Monitoring Requirements

Countries should systematically monitor: 1

• Patterns of antibiotic use 1
• Trends in antimicrobial resistance development 1
• Proportions of patients without access to essential antibiotics 1

The WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) provides standardized methodology, though only 14% of countries actively report consumption data. 1