The 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, Vabomere, Xerava, and Zemdri, unmet needs remain for additional effective treatment options. Commercial opportunities exist 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.


  • 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 the 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 different emerging therapies targeting antibiotic-resistant pathogens address current unmet needs? What emerging therapies do infectious disease (ID) specialists consider as the most promising, and where will these therapies be used?
  • What attributes will emerging therapies need to improve on in order to compete with currently marketed products? What challenges will they face?

Geographies: United States, EU5, Japan

Primary Research: More than 20 country-specific interviews with thought-leading infectious diseases specialists supported by survey data collected for this and other DRG research.

Epidemiology: Diagnosed events of GNIs, segmented by key indications (NP, cSSSIs/SSIs, BSIs, cIAIs, UTIs), pathogens (E. coli, Pseudomonas, Acinetobacter, Klebsiella), resistance, and country.

FORECAST: Ten-year, annualized, drug-level sales and patient share of key GNI therapies through 2028, segmented by brands / generics, geography, and five key indications.

Emerging Therapies: Phase III / PR: 11 drugs. Phase II: 4 drugs; coverage of select preclinical and Phase I products


Disease Landscape & Forecast provides comprehensive market intelligence with world-class epidemiology, keen insight into current treatment paradigms, in-depth pipeline assessments, and drug forecasts supported by detailed primary and secondary research.

Table of contents

  • Hospital-Treated Gram-Negative Infections - Landscape & Forecast - Disease Landscape & Forecast

Author(s): Archita Kukreja; Fjoralba Kristo, MD, MPH

Archita is a member of Decision Resources Group’s Infectious, Niche, and Rare Diseases (INRD) team. In this role she works on a range of antibacterial and antiviral indications as well as numerous niche and rare diseases.

Archita holds a Masters in Science degree in biotechnology from Jamia Millia Islamia, New Delhi and has completed her MBA from Amity University, Noida.

Fjoralba Kristo has expertise in forecasting infectious diseases and chronic diseases in both the mature and global markets. She has extensive academic experience with quantitative and qualitative research methods.

Prior to joining Decision Resources Group, she completed a postdoctoral fellowship at University of Kentucky, Division of Cardiovascular Medicine, and more recently worked as Research Scientist at Massachusetts General Hospital, where she investigated mechanisms of inflammation in cardiovascular diseases. Fjoralba holds an MPH degree from Boston University School of Public Health, concentrating in Epidemiology and Biostatistics, and a medical degree from University of Medicine, Bucharest, Romania.