Rising rates of antimicrobial resistance have created an urgent need for antibiotics with activity against drug-resistant gram-negative pathogens (GNPs). Antibiotics such as carbapenems, which have historically been reserved for later lines of therapy, are being used earlier in treatment, placing additional pressure on the already limited gram-negative infection (GNI) armamentarium. Despite the launch of antibiotics such as Avycaz/Zavicefta, Zerbaxa, and Vabomere, unmet needs remain for additional effective treatment options. There are commercial opportunities for emerging therapies with efficacy in patients with drug-resistant infections, especially those associated with high rates of mortality. However, the market is heavily genericized, and cost-containment measures may limit commercial success.

Questions Answered:

  • What are the drivers and constraints in the HT-GNI market, and how will the market evolve over the forecast period? How will rising antibiotic resistance rates and entry of new generics shape the market?
  • How large are the different GNI indications? What are the resistance rates to different classes of antibiotics across several pathogen species?
  • How will emerging therapies such as Merck’s imipenem/cilastatin/relebactam, Achaogen’s plazomicin, Tetraphase’s eravacycline, or Shionogi’s cefiderocol address current unmet needs? What emerging therapies do ID specialists consider the most promising?
  • What attributes will emerging therapies need to improve on to compete with currently marketed products?

GNIs account for a large portion of hospital-treated infections (HTIs), which represent a high-value segment of the antibacterial market given the severity of these infections. In the past, developers have focused heavily on anti-gram-positive therapies, such as those against methicillin-resistant Staphylococcus aureus (MRSA), which has allowed the number of antibiotics for GNIs in the late-stage pipeline to dwindle. Therefore, the GNI market provides wide market opportunity for developers that can tackle segments of unmet need. In particular, rising multidrug resistance in key GNPs (e.g., Pseudomonas aeruginosaAcinetobacter baumanniiEscherichia coli, and Klebsiella pneumoniae) leaves physicians with limited therapeutic options. With fewer alternatives, high-volume use of several current agents creates selective pressure for the further development of drug resistance to therapy. Thus, opportunity exists for developers that can provide therapies to not only overcome drug resistance to current treatments but that are safe and tolerable and can stave off the emergence of antibiotic resistance by using novel mechanisms of action.