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    Rising Drug-Resistance Rates Continue to Erode the Utility of Frontline Antibiotics, Driving Uptake of New Antibiotic Brands in the Hospital-Treated Gram-Negative Infections Market

    The hospital-treated Gram-negative infection (GNI) market continues to be dominated by well-entrenched, generically available antibiotics (e.g., piperacillin/tazobactam, ceftriaxone, fluoroquinolones). These agents are used as front-line therapies and are effective for the majority of GNI inpatients today. However, prescribers voice serious concerns over climbing rates of antimicrobial resistance in GNIs in particular, worried about the declining utility of the current antibiotic armamentarium.

    Our primary market research shows that potent antibiotics, like carbapenems (i.e., Invanz, Doribax, meropenem, imipenem/cilastatin), are increasingly being used in earlier lines of therapy. Indeed, approximately 40% of surveyed ID specialists report increased use of carbapenems in the past 12 months, and nearly all of these respondents cite the growing prevalence of extended spectrum beta-lactamase (ESBL) -producing bacteria as a key driver for their increased prescribing.

    Carbapenem-resistant infectios (CRIs) are concerning to physicians because safe and efficacious treatment options for inpatients with these infections are limited. As such, the primary value proposition for the most recent antibiotics to enter the U.S. GNI market, Merck’s Zerbaxa and Allergan’s Avycaz, is their activity against these key drug-resistant bacteria. Nevertheless, the high cost of these branded products compared to generic agents, and concerns over selective pressure leading to resistance to these potent drugs, will continue to limit their prescribing.

    Key findings from the Current Treatment report on Gram-Negative Infections:

    • Compared to ID specialists surveyed in 2016, 2017 survey respondents reported an even higher proportion of their GNI patients test positive for a fluoroquinolone-resistant pathogen.
    • Surveyed ID specialists report that up to a quarter of their GNI inpatients in the past 12 months were admitted to the hospital following treatment failure in the outpatient setting.
    • Although the majority of GNI inpatients are prescribed empiric therapy providing Gram-negative coverage, approximately 40% of those inpatients are not successfully treated.
    • More than one-third of GNI inpatients initiated on Avycaz and over one-fifth of those initiated on Pfizer’s Tygacil, or Zerbaxa, were previously treated with meropenem or imipenem/cilastatin.