Multidrug resistant bacteria pose a major health problem.1 2 In the European Union alone infections with these bacteria cause around 25 000 deaths a year.3 The economic burden associated with these infections is immense. One estimate suggests a total yearly loss of $21bn-$34bn (£14bn-£22bn; €15bn-€25bn) in the United States.4 Two thirds of deaths are due to infection with Gram negative bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae.

New antibiotics to tackle resistant bacteria are urgently needed. Yet a recent report from the European Centre for Disease Prevention and Control and European Medicines Agency warns of an almost empty pipeline.3 Only two new drugs are under development; both are in the early stages when failure rates are high.

Six months ago, the Council of the European Union called on the European Commission to develop proposals to promote the research and development of new antibiotics for multidrug resistant Gram negative pathogens,5 and the EU and US have set up a transatlantic taskforce on antimicrobial resistance.6 We analyse some of the mechanisms that could be used to stimulate drug companies to research and develop new antibiotics and suggest which are the most promising. Further analysis is available in the report commissioned by the Swedish presidency of the European Union.7