世界卫生组织与20国抗菌药基本药物目录比较分析

A comparative study on antibacterial agents in national list of essential medicines from WHO and other twenty countries

目的:着重20国基本药物目录中抗菌药比较,以全面理解我国基本药物的重要价值和用药水准。方法:检索WHO官方网站、各国卫生部和药物监管部门官方网站,收集各国的基本药物目录。通过自制数据表格,比较20国经济水平、健康投入和产出情况以及目录的时效性,着重比较抗菌药品种的种类、数量和具体药物。结果:人均GDP、人均卫生费用和卫生费用占GDP比例均以澳大利亚最高(46710I$,4242I$,11.0%)。而阿富汗、巴基斯坦和印度尼西亚分别位列最低,人均GDP为330I$,人均卫生费用63I$和卫生费用占GDP的2.4%。WHO目录含抗菌药29个,中国含21个,20国的中位数为29个。目录中含最少抗菌药的国家是马来西亚(11个),最多的是叙利亚,涵盖最多的是青霉素类品种(14个)、头孢菌素类品种(第一代至四代头孢菌素)、大环内酯类品种(7个)和氨基糖苷类品种(6个)。结论:由于各国经济、细菌耐药情况和医疗卫生服务水平不同,各国收录的抗菌药品种数量差异较大,但具体品种差异较小。我们可借鉴澳大利亚、印度、加纳等国的经验,优化基本药物的遴选机制和标准治疗指南,使国家基本药物目录更趋完善。

Objective： To provide suggestion on the selection of essential medicines for policy-makers through the review of the National List of Essential Medicine（ NLEM） from WHO and other twenty countries. Methods： The published NLEMs were selected by searching the official websites of WHO and the health authorities,like the departments of health and pharmaceutical administrations. Economy of twenty countries,input-output analysis on health,the time of NLEM published,antibacterial category,and number of antibacterials were compared. Results： Australia topped the list of real GDP per capita,per capita expenditure on health,and expenditure on health as percentage of GDP while Afghanistan,Pakistan and Indonesia were separately at the bottom of the list. The number of antibacterials in the WHO EML and the NLEM of China is 29 and 21, respectively. The number of antibacterials is the most in the NLEM of Syria and the least in the NLEM of Malaysia. The NLEM of Syria owned the most number in penicillins,cephalosporins,cephamycins and other β-lactams,aminoglycosides and macrolides. Conclusions： The difference was great in the numbers of antibacterials among NLEMs and was small in the antibacterial assortment. To develop a better NLEM,we can learn from the experience of other countries,like Australia,India and Ghanahow to select essential medicines and make guidelines for standard treatment.