Generically available IV antibiotics commonly used as outpatient parenteral antibiotic therapy (OPAT) (e.g., IV vancomycin, daptomycin) have extensive clinical histories, benefit from strong physician familiarity, and garner the majority of the OPAT market for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Furthermore, oral antibiotics (e.g., Merck & Co.’s Sivextro, generic oral linezolid) experience uptake in the outpatient setting and are competition for established OPAT drugs and follow-on long-acting agents, including Allergan’s Dalvance and the Medicines Company’s Orbactiv. New and older brands will need to offer improvements in key areas of differentiation to gain uptake in this crowded market.

Questions Answered:

Generic IV  vancomycin and daptomycin dominate the OPAT market for the treatment of MRSA infections. What is the current uptake of branded IV agents in first-, second-, and third-line treatment of outpatients diagnosed with skin infections, diabetic foot infections, or bone and joint infections caused by MRSA?

Inpatients are the most important patient population for OPAT drugs as the majority of MRSA patients initiate OPAT following hospitalization. What are the most important factors that influence OPAT initiation and drug selection? What are the top reasons why outpatients discontinue their initial OPAT protocol prematurely (by product)?

Convenience, safety, and stronger efficacy in difficult-to-treat MRSA infections are the key areas of product differentiation for branded IV antibiotics. How do prescribers anticipate changing their use of branded products for OPAT in the next 12 months? What are the most frequently encountered clinical obstacles that limit brand prescribing as OPAT? How do reimbursement and access hurdles affect the prescribing of brands?

Branded products for OPAT have limited use as first-line therapies. Which therapies are MRSA outpatients usually administered before they are initiated on branded products such as Allergan’s Teflaro? How have the long-acting agents Allergan’s Dalvance and the Medicines Company’s Orbactiv influenced the management of MRSA infections in the outpatient setting? How will the availability of generic oral linezolid and daptomycin affect the uptake of OPAT drugs and the prescribing of Sivextro?


Markets covered: United States

Methodology: Surveys of 103 infectious disease (ID) specialists, completed in March 2017.

Indication coverage: MRSA infections, including skin infections, diabetic foot infections, and bone and joint infections caused by MRSA.

Key drugs covered: Dalvance, Orbactiv, Sivextro, Teflaro, Tygacil, Vibativ, daptomycin, linezolid, vancomycin.

Key companies mentioned: Allergan, Clinigen, the Medicines Company, Theravance, Novartis, Merck, Pfizer.

Table of contents

  • Detailed, Expanded Analysis of Outpatient Parenteral Antibiotic Therapy (OPAT) for MRSA infections (US)
    • Key Updates
      • December 2017
      • September 2017
    • Introduction to Current Treatment for MRSA OPAT
      • Key Findings
      • Summary Figures
      • Introduction to Current Treatment and Medical Practice for MRSA OPAT
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • BJIs, BSIs, and cSSSIs/ABSSSIs Are the Most Common Infections Managed with Anti-MRSA OPAT
      • Physician Treatment Practices
        • Branded OPAT Drugs Are Reserved for Later-Line Treatment and for Severe or Difficult-to-Treat MRSA Infections
        • Time to Treatment Start
        • Treatment Rates
        • Brand and Product Use for MRSA OPAT
        • Treatment Duration by Product
        • Prescribing Practices by Line of Therapy
        • Combination/Regimen/Comedication Analysis
      • Physician Insight on Compliance and Persistency
        • Compliance and Persistency Are High Among OPAT Patients
      • Sequencing of Treatment
        • Oral Linezolid, Oral Tedizolid, and Daptomycin Are Top Switch Therapies at Discharge or in the Outpatient Setting for MRSA Inpatients
      • Recent and Anticipated Changes in Treatment Practices
        • Ceftaroline, Dalbavancin, and Oritavancin Will Be Prescribed More as OPAT for MRSA Patients
    • Physician Insight on Medical Practice
      • Key Findings
      • Factors Influencing Treatment Practice
        • OPAT Drug Selection Is Heavily Influenced by the Overall Cost Savings
        • Factors Influencing Disease Management
        • Major Drivers of Brand Use/Treatment
        • Major Obstacles to Brand Use/Treatment
        • Insight on Treatment Failure/Brand Issues
    • Methodology
      • Primary Market Research Methodology
    • Appendix
      • Primary Market Research

Author(s): Jiamin Zhuo, PhD

Jiamin Zhuo, is a business insights analyst on the infectious, niche, and rare diseases team at Decision Resources Group. He provides expert insight into the commercial aspects of drug development and market dynamics in bacterial infections, including gram-negative infections and Methicillin-resistant Staphylococcus aureus . He attained his at the Mayo Graduate School, Mayo Clinic, in Minnesota and his in physiology from Peking University in China. Prior to joining DRG, Dr. Zhuo was a postdoctoral fellow at Boston University and MIT, where he gained extensive experience in quantitative research methods.