Model List of Essential Medicines, 24th list

What this guideline says

GMJ summary

The 24th WHO Model List of Essential Medicines (EML) presents a comprehensive, evidence-based selection of medicines needed for a functioning health system. The core list defines minimum requirements for basic health care, prioritizing efficacy, safety, and cost-effectiveness for priority conditions. The complementary list includes medicines for diseases requiring specialized diagnostic facilities, monitoring, or training.

This edition organizes 510 medicines across 30 therapeutic categories, from anaesthetics and analgesics through to dental preparations. The AWaRe (Access, Watch, Reserve) classification guides rational antibiotic use to combat antimicrobial resistance. Significant sections cover antiretrovirals for HIV, directly-observed antituberculosis regimens, essential cancer medicines, vaccines aligned with SAGE recommendations, and reproductive health products. The list emphasizes fixed-dose combinations, paediatric formulations, and quality-assured biosimilars where appropriate.

The 2025 edition includes corrigenda correcting dosage formulations for perindopril + amlodipine + indapamide, valsartan + amlodipine + hydrochlorothiazide, and semaglutide. Medicines are listed with specific strengths, dosage forms, and—where relevant—age/weight restrictions, therapeutic alternatives, and clinical indications, enabling countries to adapt selections to local epidemiology, regulatory status, and resource availability.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Antibiotics classified into Access (first-line, e.g. amoxicillin 250–500 mg, gentamicin 10–40 mg/mL), Watch (higher resistance risk, e.g. ceftriaxone 250 mg–2 g, ciprofloxacin 250–500 mg), and Reserve (last-resort, e.g. meropenem 500 mg–1 g, linezolid 600 mg) groups to guide stewardship.
2. First-line antiretrovirals: dolutegravir 50 mg tablet, tenofovir disoproxil fumarate 300 mg, lamivudine 150 mg, efavirenz 400–600 mg; paediatric dispersible formulations (e.g. dolutegravir 5 mg, abacavir 60 mg) and fixed-dose combinations endorsed.
3. Essential antituberculosis medicines include rifampicin 150–300 mg, isoniazid 100–300 mg, pyrazinamide 400–500 mg, ethambutol 100–400 mg dispersible tablets for children, bedaquiline 100 mg for MDR-TB, and delamanid 50 mg.
4. Cancer medicines span cytotoxics (e.g. cyclophosphamide 500 mg–2 g, doxorubicin 10–50 mg), targeted therapies (imatinib 100–400 mg, rituximab 100–500 mg IV), immunomodulators (pembrolizumab 25 mg/mL IV for PD-L1+ NSCLC, cervical, colorectal cancer), and supportive care (filgrastim, zoledronic acid 4 mg).
5. Maternal and neonatal care: oxytocin 10 IU IM for postpartum haemorrhage, magnesium sulfate 0.5 g/mL (50%) for eclampsia, dexamethasone 4 mg/mL for preterm labour, misoprostol 200 µg for incomplete abortion, carbetocin 100 µg (heat-stable) for PPH prevention.
6. Paediatric-specific listings: oral rehydration salts with zinc sulfate 20 mg dispersible for diarrhoea, amoxicillin 125–250 mg/5 mL dispersible, artemether 20 mg + lumefantrine 120 mg dispersible for malaria, ready-to-use therapeutic food for severe acute malnutrition.
7. Cardiovascular medicines: lisinopril 10–20 mg + amlodipine 5–10 mg, telmisartan 40–80 mg + hydrochlorothiazide 12.5–25 mg, perindopril 5–10 mg (arginine) + amlodipine 5–10 mg + indapamide 1.25–2.5 mg triple-therapy tablets, bisoprolol 1.25–5 mg, simvastatin 5–40 mg for secondary prevention.
8. Diabetes: human insulin (short-acting 40–100 IU/mL, intermediate-acting NPH 40–100 IU/mL), insulin analogues (glargine, lispro 100 IU/mL), metformin 500 mg, empagliflozin 10–25 mg, gliclazide 30–80 mg controlled-release, semaglutide 0.68–2.68 mg/mL injection (biosimilars included).

AWaRe classification of essential antibiotics (examples from the document)

Table extracted from the guideline

Source: World Health Organization, Model List of Essential Medicines, 24th list. Reproduced in summary form.

What changed in this edition

Versus the previous edition

• Corrigendum 20 October 2025: perindopril + amlodipine + indapamide corrected to 5 mg (arginine) + 5 mg + 1.25 mg; 5 mg (arginine) + 10 mg + 1.25 mg; 10 mg (arginine) + 5 mg + 2.5 mg; 10 mg (arginine) + 10 mg + 2.5 mg.
• Corrigendum: valsartan + amlodipine + hydrochlorothiazide order corrected to 160 mg + 5 mg + 12.5 mg; 160 mg + 5 mg + 25 mg; 160 mg + 10 mg + 12.5 mg; 160 mg + 10 mg + 25 mg; 320 mg + 10 mg + 25 mg.
• Corrigendum: semaglutide injection strength corrected to 0.68 mg/mL; 1.34 mg/mL; 2.68 mg/mL (added 2.68 mg/mL).
• Therapeutic alternatives denoted by ☐ symbol now indicate 4th-level ATC chemical subgroups for many classes (e.g. ACE inhibitors, ARBs, dihydropyridines, fluoroquinolones, statins) to guide national selection based on local availability and cost.
• Emphasis on quality-assured biosimilars explicitly noted for adalimumab, rituximab, trastuzumab, pembrolizumab, filgrastim, pegfilgrastim, and erythropoiesis-stimulating agents.
• Expanded paediatric formulations including dispersible tablets for ethambutol, pyrazinamide, dolutegravir, and granules for antiretrovirals.
• Inclusion of novel agents: ansuvimab, atoltivimab + maftivimab + odesivimab for Ebola; cefiderocol, ceftolozane + tazobactam, meropenem + vaborbactam in Reserve antibiotics; elexacaftor + tezacaftor + ivacaftor for cystic fibrosis (complementary).
• Vaccines section aligned with May 2025 SAGE recommendations, now including malaria vaccine [c], respiratory syncytial virus vaccine, mpox vaccine, and reference to living position papers at https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers.

From the guideline

Verbatim

“Access group antibiotics should be widely available, affordable and quality assured… Watch group antibiotics should be prioritized as key targets of stewardship programs and monitoring… Reserve group antibiotics should be treated as 'last resort' options.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

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