By Celine Pulcini (ESGAP EC member)
In 2011, the ESCMID Study Group for Antibiotic Policies (ESGAP) performed a study which showed that 22 out of 33 old but potentially useful antibiotics were marketed in fewer than 20 of the included 38 countries in Europe, US, Canada and Australia; economic motives were the major cause for absence of marketing of these antibiotics. (Pulcini C, Bush K, Craig WA, Frimodt-Moller N, Grayson ML, et al. (2012) Forgotten antibiotics: an inventory in Europe, the United States, Canada, and Australia. Clin Infect Dis 54: 268-274.)
ESGAP and the international network Action on Antibiotic Resistance (ReAct), updated in 2015 this 2011 survey regarding market availability of these selected antibiotics in Europe, the US, Canada and Australia (See here). The situation was worse than in 2011, with even fewer antibiotics available; overall, 25/36 selected antibiotics were marketed in 20/39 countries or less.
Economic motives were also the major cause reported for absence of marketing of these antibiotics. Barriers to new availability of antibiotics that had not previously been registered in a country included:
- high registration costs
- small market size and volume sales (partly due to lack of demand and low use by clinicians, as well as absence of recommendation of these drugs in national/international guidelines)
- low prices, leading to a perceived lack of return on investment for pharmaceutical companies
- lack of awareness or low priority of the problem by health authorities..
We must all fight to ensure access to old antibiotics worldwide, including paediatric formulations, meaning that these antibiotics should be marketed and that prolonged shortages should be avoided.