New CDC publication: "The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings"

12 October, 2018

(with thanks to AMR-NAP)

This new publication from CDC on antibiotic stewardship programmes focuses on strategies for low and middle income countries:

It is interesting that the first recommendation under 'Intermediate level national activities' is as follows:


Develop and ensure access to recommended formularies.

Formularies are lists of antibiotics that are suggested for certain healthcare settings. In developing a recommended formulary, countries should consider the needs of patients and facilities where they receive care. For example, clinicians in rural or primary health centers may need wide access to first-line antibiotics (e.g., penicillin, ampicillin, TMP-SMX), but last resort antibiotics such as carbapenems or colistin might be limited to tertiary care hospitals. Efforts to create antibiotic formularies may be linked to efforts within countries to create or update essential medicine lists (EML). The WHO is developing a version of the EML that takes into account some of these considerations, including three categories of antibiotics, “ACCESS”, “WATCH”, and “RESERVE” [33].

The ACCESS category are antibiotics recommended to be available at all times for a wide range of common infections; WATCH are first or second-choice antibiotics, which should be used carefully to avoid further resistance; and RESERVE antibiotics are last-resort options that should only be used in severe or rare situations. The WHO document “How to Develop a National Formulary Based on the WHO Model Formulary - A Practical Guide” is available to help countries develop a recommended list of antibiotics [34]. Once recommended antibiotic formularies are established, it is critical to take steps to ensure that national procurement and supply systems are able to reliably support access to the recommended medications.


Comment (Neil PW): Many formularies are indeed simply lists of antibiotics (and other drugs). However, a simple list is of limited value. I and many other members use, or will have used, the British National Formulary (although targeted to UK it is popular in anglophone LMIC countries). The BNF provides not only lists of medicines, but also guidance on how to select the appropriate medicine in any given clinical context, together with an indication of costs. Online use of the BNF is possible through Hinari but this is not much use to those with limited internet access. Offline use is not possible without payment, even for those in LMICs.

Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (, which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: