Intended for healthcare professionals

Analysis Health Systems Perspectives

Stoking the antibiotic pipeline

BMJ 2010; 340 doi: (Published 18 May 2010) Cite this as: BMJ 2010;340:c2115
  1. Chantal M Morel, research fellow1,
  2. Elias Mossialos, professor of health policy12
  1. 1LSE Health, London School of Economics and Political Science, London WC2A 2AE
  2. 2European Observatory on Health Systems and Policies, London
  1. Correspondence to: C M Morel c.m.morel{at}
  • Accepted 25 March 2010

New antibiotics to tackle multidrug resistant bacteria are much needed. Chantal Morel and Elias Mossialos show how financial incentives might be used to persuade drug companies to develop them

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

Why the antibiotic pipeline is dry

Industry has been reluctant to invest in research and development of antibiotics. In 2004, only 1.6% of drugs in development by the world’s 15 largest drug companies were antibiotics.8 The lack of investment is due to several factors. Firstly, there are many generic antibiotics on the market …

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