Download Sections 11 to 17

WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
11. BLOOD PRODUCTS AND PLASMA SUBSTITUTES
11.1 Plasma substitutes
*dextran 70
injectable solution, 6%
EDL2 Replaced dextran 40. To
increase plasma volume
Cochrane Library: One review on
crystalloids and colloids
*polygeline
injectable solution, 3.5%
EDL6 Advantages over dextran-only
one plasma substitute is necessary
Cochrane Library: One review on
crystalloids and colloids
11.2 Plasma fractions for specific use
All plasma fractions should comply with the WHO 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. Albumin removed EDL 11
Complementary drugs
*factor VIII concentrate
(C) (2, 8)
(dried)
For specific coagulation disorders
*factor IX complex
concentrate (coagulation
factors, II, VII, IX, X)
(C) (2, 8)
(dried)
For specific coagulation disorders
tablet, 50 mg, 100 mg
EDL7 Cardioselective Badrenoreceptor antagonists (Beta
blocker) advantageous in some patients
Cochrane Library: Number of reviews
For acute treatment of angina
Tablets have limited shelf life
12. CARDIOVASCULAR DRUGS
12.1 Antianginal drugs
*atenolol
glyceryl trinitrate
tablet (sublingual), 500 micrograms
Section 2 Page 1 of 13
CE6 Strong evidence of effect
especially in those at greatest risk of
death after an MI
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Cochrane Library: No reviews but
RCTs exist
*isosorbide dinitrate
*verapamil
(10)
tablet (sublingual), 5 mg
For treatment of angina
CE6 Insufficient evidence of effect in
unstable angina on rates of death or MI
tablet, 40 mg, 80 mg (hydrochloride)
EDL8 Added replaces nifedipine for
angina. For treatment of angina
Cochrane Library: One review in
pregnancy and RCTs exist
tablet, 50 mg, 100 mg
EDL7 Beta blocker Variety of uses
especially SVT and post myocardial
infarct
Cochrane Library: Number of reviews
tablet, 62.5 micrograms, 250 micrograms;
oral solution 50 micrograms; injection 250
micrograms/ml in 2-ml ampoule
EDL10 Antiarrhythmic
Major cause of ADRs
Variety of uses especially heart failure
and AF
CE6 Digoxin is no better than placebo
at restoring sinus rhythm in acute AF
but lowers ventricular rate in the short
term
injection, 20 mg (hydrochloride)/ml in 5-ml
ampoule
Ventricular arythmias especially after
myocardial infarct. First line
emergency use.
Cochrane Library: No reviews or RCTs
found
tablet, 40 mg, 80 mg (hydrochloride);
injection, 2.5 mg (hydrochloride)/ml in 2-ml
ampoule
Used for SVTs usually by injection
followed by oral use.
Cochrane Library: No reviews but
RCTs exist
12.2 Antiarrhythmic drugs
*atenolol
digoxin
(4, 11)
lidocaine
verapamil
(8, 10)
Complementary drugs
Section 2 Page 2 of 13
CE6 verapamil is no better than
placebo at restoring sinus rhythm in
acute AF but lowers ventricular rate in
the short term
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
epinephrine (adrenaline)
(C)
injection 1 mg (as hydrochloride) in 1-ml
ampoule
Used in cardio-pulmonary resuscitation
Cochrane Library: One review and
RCTs exist
isoprenaline
(C)
injection, 20 micrograms (hydrochloride)/ml
EDL8 For emergency treatment of
bradycardia
Cochrane Library: No reviews but
RCTs exist
*procainamide
(B)
tablet, 250 mg, 500 mg (hydrochloride);
injection, 100 mg (hydrochloride)/ml in 10ml ampoule
For ventricular arythmias especially
after myocardial infarct
Cochrane Library: No reviews but
RCTs exist
*quinidine
(A) (7)
tablet, 200 mg (sulfate)
Suppression of SVTs and ventricular
arythmias
Cochrane Library: No reviews but
RCTs exist
tablet, 50 mg, 100 mg
Beta blocker Variety of uses including
hypertension
Cochrane Library: Number of reviews
ACE inhibitor for essential
hypertension. Also used in combination
with thiazide diuretics
Cochrane Library: Number of reviews
12.3 Antihypertensive drugs
*atenolol
*captopril
scored tablet, 25 mg
CE6 Two SRs show reduction in
mortality and morbidity with minimal
side effects
CE6 Two SRs show reduction in
mortality and morbidity with minimal
side effects
*hydralazine
tablet, 25 mg, 50 mg (hydrochloride); powder
for injection, 20 mg (hydrochloride) in
ampoule
Used with other agents for moderate to
severe hypertension
CE6 effective in reducing serious
hypertension in pregnancy
*hydrochlorothiazide
scored tablet, 25 mg
Thiazide diuretic. First line
antihypertensive treatment
CE6 Two SRs show reduction in
mortality and morbidity with minimal
side effects
Section 2 Page 3 of 13
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
methyldopa
(7)
tablet, 250 mg
Centrally acting antihypertensive
Cochrane Library: Number of reviews
*nifedipine
(10)
sustained release formulations, tablet 10 mg
Relaxes vascular smooth muscle and
dilates coronary and peripheral arteries
CE6 Calcium channel blocker given in
first few days post MI do not reduce
deaths but may increase death in those
with reduced left ventricular function
Calcium channel blocker
*reserpine
tablet, 100 micrograms, 250 micrograms;
injection, 1 mg in 1-ml ampoule
Antihypertensive that reduces
catecholamines both peripherally and
centrally
Cochrane Library: One review in the
elderly
Complementary drugs
*prazosin
(B)
tablet, 500 micrograms, 1 mg
EDL11 Replaces doxazosin as Aadrenoreceptor antagonist, less
expensive
Cochrane Library: One review in
pregnancy and RCTs
*sodium nitroprusside
(C) (2, 8)
powder for infusion, 50 mg in ampoule
EDL2 For emergency use in
hypertensive crises
Cochrane Library: No reviews but
RCTs exist
scored tablet, 25 mg
EDL10 New section-cardiac failure.
ACE inhibitor.
Cochrane Library: Number of reviews
Cardiac glycoside.
Major cause of ADRs
12.4 Drugs used in heart failure
*captopril
*digoxin
(4, 11)
(4, 11)
tablet, 62.5 micrograms, 250 micrograms;
oral solution, 50 micrograms/ml; injection,
250 micrograms/ml in 2-ml ampoule
CE6 Two SRs and recent RCTs show
Ace inhibitors reduce mortality,
hospital admission and ischaemic
effects in heart failure
Cochrane Library: One review
CE6 Evidence that digoxin reduces
morbidity in heart failure
Section 2 Page 4 of 13
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
dopamine
injection, 40 mg (hydrochloride)in 5-ml vial
Cochrane Library: reviews exist
*hydrochlorothiazide
tablet, 25 mg, 50 mg
Thiazide diuretic
Cochrane Library: reviews exist
tablet, 100 mg
Low dose aspirin used to prevent
platelet aggregation
CE6 routine use is beneficial unless
other contra-indications. 75mg is as
effective as higher doses. Reduces
mortality: one life saved for every 40
treated in acute MI. Also of value if
started within 48 hours of acute
ischaemic attack
powder for injection, 100,000 IU, 750,000 IU
in vial
EDL7 For the Rx of patients a few
hours after coronary thrombosis So
called 'clot buster'
CE6 Prompt treatment within 6 hrs and
perhaps up to 12 hours reduces
mortality in acute MI
12.5 Antithrombotic drugs
acetylsalicylic acid
Complementary drug
streptokinase
(C)
12.6 Lipid-lowering agents
The WHO Expert Committee on Use of Essential Drugs recognizes the value of lipid-lowering drugs in treating patients with hyperlipidaemia. HMG-CoA reductase inhibitors,
often referred to as "statins", are a family of potent and effective lipid-lowering 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 mortality (all causes), as well as the need for coronary by-pass surgery . All remain very costly but may be
cost effective for secondary prevention of cardiovascular disease as well as for primary prevention in some very high-risk 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 the national level.
13. DERMATOLOGICAL DRUGS (topical)
13.1 Antifungal drugs
Section 2 Page 5 of 13
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
benzoic acid + salicylic acid
ointment or cream, 6% + 3%
Also known as Whitfields ointment.
Used for ringworm
Cochrane Library: one review of
topical treatments for fungal infections
*miconazole
ointment or cream, 2% (nitrate)
For candidal skin infections
Cochrane Library: one review of
topical treatments for fungal infections
sodium thiosulfate
solution, 15%
EDL7 For pityriasis versicolor
Cochrane Library: No reviews or RCTs
detergent-based suspension, 2%
EDL6 For the treatment of pityriasis
versicolor and seborrhoeic dermatitis
Cochrane Library: No reviews or RCTs
aqueous solution, 0.5%; tincture, 0.5%
EDL4 Considered at EDL 11 but felt
benefits outweighed risks. Topical
antiseptic
Should be confined to use on unbroken
skin
Complementary drug
selenium sulfide
(C)
13.2 Anti-infective drugs
*methylrosanilinium
chloride (gentian violet)
Cochrane Library: No reviews but
RCTs exist
neomycin sulfate +
*bacitracin
ointment, 5 mg + 500 IU bacitracin zinc/g
Topical antibiotic ointment
Cochrane Library: No reviews but
RCTs exist
*potassium permanganate
aqueous solution 1:10 000
EDL9 Very inexpensive anti-infective
agent. Main use in mycotic infections
of the feet
Cochrane Library: No reviews but one
RCT
silver sulfadiazine
cream, 1%, in 500-g container
EDL5 For treatment of burns. Topical
antibiotic to treat and prevent infection
Cochrane Library: No reviews but
RCTs exist
13.3 Anti-inflammatory and antipruritic drugs
Section 2 Page 6 of 13
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*betamethasone
(3)
ointment or cream, 0.1% (as valerate)
Potent topical steroid
Cochrane Library: No reviews but
RCTs exist
CE6 small short term RCTs over 1-4
weeks show improvement over
placebo.
*calamine lotion
lotion
For mild pruritus
Effective ?
Cochrane Library: No reviews or RCTs
*hydrocortisone
ointment or cream, 1% (acetate)
Mild topical steroid
Cochrane Library: No reviews but
RCTs exist
solution, 13% for dilution
For exudative wounds and eczematous
reactions. Final solution (0.65%) must
be freshly prepared
Dilute 5ml of 13% solution to 100ml
for use.
13.4 Astringent drugs
aluminium diacetate
Cochrane Library: No reviews or RCTs
exist
13.5 Drugs affecting skin differentiation and proliferation
benzoyl peroxide
lotion or cream, 5%
EDL6 For treatment of acne
Cochrane Library: No reviews but
RCTs exist
coal tar
solution, 5%
As an ingredient in topical ointments to
treat psoriasis and possibly chronic
atopic eczema.
Cochrane Library: No reviews but
RCTs exist
Section 2 Page 7 of 13
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
dithranol
ointment, 0.1%-2%
EDL5 For the treatment of psoriasis
Cochrane Library: No reviews but
RCTs exist
CE6 evidence of effect in chronic
plaque psoriasis for treatment and
remission.
fluorouracil
ointment, 5%
Cytotoxic for malignant and premalignant skin lesions.
CE6 no evidence of effect in genital
warts
solution, 10-25%
EDL4 added to main list. For anogenital warts.
CE6 RCTs show podophyllum to be as
effective as other treatments but less
effective than surgical excision
salicylic acid
solution 5%
EDL2 Effective, commonly used and
inexpensive. For plantar warts
Cochrane Library: one review of
topical treatments for fungal infections
urea
ointment or cream, 10%
EDL9 very inexpensive keratolytic
agent without scientific evaluation
Cochrane Library: No reviews but
RCTs exist
lotion, 25%
Used to treat scabies
Not recommended in children
*podophyllum resin
(7)
13.6 Scabicides and pediculicides
*benzyl benzoate
CE6 little evidence of effect- may be
less than 50% cure rate
permethrin
cream 5%; lotion 1%
EDL6 Replaces lindane, cheaper
(lindane=gamma benzene
hexachloride) For head lice and crab
lice
13.7 Ultraviolet blocking agents
Section 2 Page 8 of 13
CE6 effective in treatment of scabies
with cure rates of up to 90%
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Complementary drugs
topical sun protection agent
with activity against UVA
and UVB
(C)
cream, lotion or gel
EDL6 Skin protection especially people
with xeroderma pigmentosa
Cochrane Library: No reviews or RCTs
found
fluorescein
eye drops, 1% (sodium salt)
EDL2 Diagnostic agent in eye
examination relating to superficial
damage or a foreign body
Cochrane Library: No reviews but
RCTs exist
*tropicamide
eye drops, 0.5%
EDL5 Short acting mydriatic for
diagnostic ophthalmic procedures
Cochrane Library: No reviews but
RCTs exist
14. DIAGNOSTIC AGENTS
14.1 Ophthalmic drugs
14.2 Radiocontrast media
CE6 less nephrotoxicity with low osmolality media
amidotrizoate
injection, 140-420 mg iodine (as sodium or
meglumine salt)/ml in 20-ml ampoule
Ionic contrast media
barium sulfate
aqueous suspension
Contrast media for examination of the
GI tract
*iohexol
injection 140 –350 mg iodine/ml in 5-ml, 10ml and 20-ml ampoule
EDL11 Non ionic contrast media Safer
than ionic contrast media
Cochrane Library: No reviews but
RCTs exist
*iopanoic acid
tablet, 500 mg
Oral Ionic contrast media for
cholecystography and cholangiography
Cochrane Library: No reviews but
RCTs exist
*propyliodone
oily suspension, 500-600 mg/ml in 20-ml
ampoule (For administration only into the
bronchial tree.)
EDL4 For brochography. Can lead to
dyspneoa and pneumonia
EDL11 committee asked for review of
this item
Section 2 Page 9 of 13
Cochrane Library: No reviews but
RCTs exist
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Complementary drug
*meglumine iotroxate
(C)
solution, 5-8 g iodine in 100-250 ml
Ionic contrast media
Cochrane Library: No reviews but
RCTs exist
EDL11 committee asked for review of this section
15. DISINFECTANTS AND ANTISEPTICS
15.1 Antiseptics
*chlorhexidine
solution, 5% ( digluconate) concentrate for
dilution
EDL2 Commonly used antiseptic
*ethanol
solution, 70% (denatured)
EDL11 denatured added to prevent use
as a beverage. Effective antiseptic for
skin and hard surfaces
Cochrane Library: No reviews but
RCTs exist
*polyvidone iodine
solution, 10%
EDL8 Replaced iodine
Cochrane Library: No reviews but
RCTs exist
*chlorine base compound
powder (0.1% available chlorine) for solution
EDL7 name change EDL-10 originally
calcium hypochlorite. Used in cleaning
and disinfecting contaminated areas.
Effective against HIV
*chloroxylenol
solution, 5%
EDL10 Replaced phenolic disinfectants
15.2 Disinfectants
Weak disinfectant
glutaral
solution, 2%
EDL7Added as disinfectant
16. DIURETICS
Section 2 Page 10 of 13
Now not favoured as unpleasant and
toxic to use
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*amiloride
tablet, 5 mg (hydrochloride)
EDL2An effective diuretic with
potassium sparing properties
Cochrane Library: No reviews but
RCTs exist
*furosemide
tablet, 40 mg; injection, 10 mg/ml in 2-ml
ampoule
Potent loop diuretic
Cochrane Library: No reviews but
RCTs exist
*hydrochlorothiazide
tablet, 25 mg, 50 mg
Thiazide diuretic
Cochrane Library: No reviews but
RCTs exist
(8)
tablet, 25 mg
Potassium sparing diuretic potentiates
action of loop and thiazide diuretics
Cochrane Library: No reviews but
RCTs exist
(C)
injectable solution, 10%, 20%
Osmotic diuretic mainly used in
cerebral oedema.
CE6 no benefit in decreasing the risk of
acute renal function compared to other
fluids
spironolactone
(4, 7, 8)
Complementary drug
*mannitol
17. GASTROINTESTINAL DRUGS
ED11 Committee asked for a revision of all drugs for peptic ulcer
17.1 Antacids and other antiulcer drugs
aluminium hydroxide
tablet, 500 mg; oral suspension, 320 mg/5 ml
Antacid
Cochrane Library: several reviews on
dyspepsia
*cimetidine
tablet, 200 mg; injection, 200 mg in 2-ml
ampoule
EDL3 H2 antagonist reduces stomach
acid. Used to treat stomach ulcers
Cochrane Library: several reviews on
dyspepsia
CE6 Effective (SR) in relieving
heartburn. Generally PPIs more
effective
magnesium hydroxide
oral suspension, 550 mg equivalent to
magnesium oxide/10 ml
Acid and aperient
Section 2 Page 11 of 13
Cochrane Library: several reviews on
dyspepsia
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
17.2 Antiemetic drugs
metoclopramide
tablet, 10 mg (hydrochloride); injection, 5 mg
(hydrochloride)/ml in 2-ml ampoule
EDL3 Anti-nauseant and antiemetic
Cochrane Library: No reviews but
RCTs exist
*promethazine
tablet, 10 mg, 25 mg (hydrochloride); elixir or
syrup, 5 mg (hydrochloride)/5 ml; injection,
25 mg (hydrochloride)/ml in 2-ml ampoule
Antihistamine for nausea, vertigo,
motion sickness.
Cochrane Library: No reviews but
RCTs exist
ointment or suppository
Many proprietary preparations. Local
soothing action.
17.3 Antihaemorrhoidal drugs
*local anaesthetic,
astringent and antiinflammatory drug
17.4 Anti-inflammatory drugs
*hydrocortisone
(B)
suppository 25 mg (acetate); *retention
enema
For ulcerative colitis, proctitis
Cochrane Library: several reviews
*sulfasalazine
(2)
tablet, 500 mg; suppository 500 mg; retention
enema
For ulcerative colitis and maintenance
and remission of active Crohns disease
Cochrane Library: several reviews
tablet, 0.6 mg (sulfate); injection, 1 mg
(sulfate) in 1-ml ampoule
For relief of smooth muscle spasm such
as in irritable bowel and diverticular
disease
tablet, 7.5 mg (sennosides) (or traditional
dosage forms)
Stimulant laxative
17.5 Antispasmodic drugs
*atropine
17.6 Laxatives
*senna
17.7 Drugs used in diarrhoea
Section 2 Page 12 of 13
Cochrane Library: several reviews
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
17.7.1 Oral rehydration
oral rehydration salts (for
glucose-electrolyte solution)
powder, 27.9 g/l; Components to reconstitute
1 litre of glucose-electrolyte solution:
ORS Replaces fluid and salts lost in
acute diarrhoea
EDL11 committee asked for review of
this section
sodium chloride 3.5 g/l;
trisodium citrate dihydrate* 2.9 g/l; potassium
chloride 1.5 g/l;
CE6 Number of RCTs looking at
different formulations. One SR
suggests rice based ORS reduces the 24
hour stool volume
glucose, anhydrous 20.0 g/l
*Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5g/l. However, as the stability of this latter formulation is very poor under
tropical conditions, it is only recommended when manufactured for immediate use.
17.7.2 Antidiarrhoeal (symptomatic) drugs
*codeine
(1a)
tablet, 30 mg (phosphate)
Opiate that reduces gut motility
Section 2 Page 13 of 13
Cochrane Library: No reviews or
protocols