Hospital-acquired bacterial pneumonia (HABP) is one of the most common nosocomial infections. Patients with ventilator-associated bacterial pneumonia (VABP) represent an important subpopulation of HABP, and this infection can occur in patients receiving mechanical ventilation for 48 hours or more. Like HABP, VABP is associated with high rates of antibiotic-resistant pathogens and significant mortality. Although the HABP and VABP markets are highly competitive due to a number of products currently available to hospital-based physicians, including many generics, the commercial opportunity for new agents is high, given the increasing multi-drug resistance associated with the causal pathogens, as well as the persisting high mortality rates among these often critically ill patients.

This report focuses on trends in inpatient treatment of HABP and VABP infections and analyzes the physician prescribing practices for these infections, which are often caused by multi-drug resistant Gram-negative pathogens and methicillin-resistant Staphylococcus aureus (MRSA). Further, this study evaluates the advantages and disadvantages of currently available and emerging therapies for HABP and VABP and identifies opportunities for product positioning and differentiation.

Questions Answered in This Report:

  • Treatment guidelines for HABP and VABP influence prescribing practices in the inpatient setting. Do hospitals have specific treatment guidelines for pneumonia? Which drugs are included in hospital treatment guidelines for HABP or VABP? Which pathogens are included in these guidelines? Do physicians prescribe off-label therapies for HABP and VABP? Which factors impact prescribing for HABP and VABP?

  • MRSA and P. aeruginosa are clinically important pathogens in HABP and VABP, and therapies with activity against these pathogens dominate in this market. How have the rates or the number of HABP or VABP patients infected with key pathogens changed? How often is any pathogen identified as the etiological agent among pneumonia inpatients? Among microbiologically confirmed HABP or VABP, what percentage is due to key drug-resistant pathogens? What are the most commonly prescribed empiric and targeted therapies for HABP and VABP, including pneumonia due to drug-resistant pathogens? Which pathogens are specialists typically targeting in empiric therapy?

  • Pneumonia is associated with high readmission rates, according to surveyed physicians. What are the 30-day readmission rates for HABP, VABP, and CABP? What percentage of patients with CABP are admitted to the hospital for inpatient treatment? How often are patients with HABP, VABP, and CABP discharged and continued on antibiotic treatment in the outpatient setting?

  • Generic linezolid is expected to see an increase in use for the treatment of HABP and VABP. Are generic formulations of linezolid currently stocked in hospitals? Do physicians anticipate an increase in their prescribing of generic linezolid in the next 12 months? Which agent is expected to face pressure from the uptake of generic linezolid? How are prescribing trends for the treatment of HABP/VABP due to MRSA and Gram-negative pathogens expected to change in the next 12 months?

  • Physicians cite an unmet need for novel agents for the treatment of HABP and VABP and are willing to prescribe key emerging therapies such as Merck’s Sivextro and Zerbaxa and Allergan’s Avycaz. Do hospitals currently stock these recently launched agents? Have physicians prescribed these emerging therapies for the management of HABP and VABP? Will current nonprescribers prescribe these agents in the future? How will these novel drugs compete with well-established therapies and other competitive emerging therapies? For which infections do current users prescribe these agents? Under which circumstances do future prescribers plan to prescribe these agents for? Which pathogens represent areas of unmet need with respect to new treatment options?

Scope:

Markets covered: United States.

Primary research: 101 prescribers: 50 infectious disease specialists and 51 critical care/intensive care unit specialists.

Indication coverage: Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP).

Author(s): Brenda Perez-Cheeks, Ph.D.
Mladen Tomich, Ph.D.