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Antibiotics 10 x ‘20 – Progress and C i l O i iCommercial Opportunities

Tim JoslinTim JoslinManaging Director, EuropeDefined Health

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Insight Briefing – Antibiotics 7th December 2011© Defined Health 2011

The information in this presentation has been obtained from what are believed to be reliable sources and has been verified whenever possible. pNevertheless, we cannot guarantee the information contained herein as to accuracy or completeness. All expressions of opinion are the responsibility of Defined Health, and though current as of the date of this report, are subject to change.

© Defined Health, 2011


Agenda

• Community RTI Opportunity? • Community Skin Infections• Community Skin Infections• Serious Hospital Infections• Biofilms• Clostridium difficile• Alternate approaches• Conclusions


2004 IDSA Concerned, 2011 Progress, but 10 x ‘20?


Community Respiratory Infections

• Most cause Morbidity not mortality – except in very young or elderly.• AECOPD in US ~10m diagnosed patients, 726k hospitalized, 119k deaths.g p , p ,

• Vaccinations for HiB and Streptococcus reduce risk of infections in most vulnerable patients.

• Community Acquired Pneumonia (CAP) with Multidrug resistant S. pneumoniae real risk. • ~6m cases in US, 1.5m patients hospitalized, 40k deaths.

• (MR)S.aureus post-influenza a risk especially with an ever present threat of pandemic influenza.

C t it ib d th i f b t i l i f ti tl• Current community prescribed therapies for bacterial infections mostly still effective and all are generic.

• Is there enough medical need to support new drug development?


Source: www.cdc..gov Morris A. et al. J. COPD 5 (1) Feb 2008:43-51, DH Insight

HCAP – An Independent Variable For Mortality In Pneumococcal Pneumonia


S. pneumoniae Resistance Continues

• Macrolide resistance continues to be incident across all regions worldwide – most marked in Asia.

• The varying serotypes of S. pneumoniae show different levels of invasiveness.

• 19A and 19F are now covered by the Prevnar 13 vaccine. However it is likely that emergence of new invasive and multidrug resistant serotypes will occur with this and other developmental pneumococcal vaccines.


Source: Bouchillon et al Poster 242 IDSA 2011, Edwards K IDSA 2011, Cowen September 2011

S. pneumoniae Resistance in Europe 2010

Penicillin R+I Macrolide R+IPenicillin R+I Macrolide R+I


Source: EARS-Net maps

MRSA USA300 Moving from Community to Hospitals

• A single USA300 isolate found non-susceptible to vancomycin (MIC=3-4 μg/ml) and daptomycin (MIC=1.5 μg/ml)

• First reports coming of MDR US300 in UK (similar to EMRSA15 a HA MRSA) indication of


• First reports coming of MDR US300 in UK (similar to EMRSA15 a HA-MRSA) - indication of things to come?

Source: C2-1285 ICAAC 2010, C-2 073 ICAAC 2011

New Agents to Treat Community RTI’s

Attributes Required• Spectrum must include MDR S. pneumoniae, MRSA, spectrum should include atypicals

Mycoplasma, Chlamydia, Legionella +/- serious Gram –ve pathogens P. aeruginosa, K pneumoniae to cover all agesK.pneumoniae to cover all ages.

• Should be IV & oral with single/twice daily dosing. Paediatric use important.

Gram +ve inc.

RTI Gram-ve H. influenzae,

Extended RTI Gram-ve P. aeruginosa

AtypicalLegionella,

IV/oral

MRSA M. catarrhalis K. pneumoniae Mycoplasma,Chlamydophila

Omadacycline Yes Yes Yes Yes Yes

Solithromycin Yes Yes No Yes YesSolithromycin Yes Yes No Yes Yes

Delafloxacin Yes Yes Yes Yes YesPDF

GSK1322322 Yes Yes No ? Yes

NXL103 Yes Yes No Yes Oral OnlyJNJ-Q2 Yes Yes Yes Yes Yes

Finafloxacin Yes Yes Yes Yes Yes


BC-3781 Yes Yes No Yes Yes

Source: Company websites, DH Insight

Omadacycline (Paratek)• Good coverage of Gram positive blood isolates In addition to a broad spectrum of• Good coverage of Gram positive blood isolates. In addition to a broad spectrum of

Gram positive/negative and anaerobic activity.

• In the Phase II cSSTI study IV/oral omadacycline showed equivalence to linezolid IV/oral (CE population 98% v 93%; ME population 97% v 94%).

• Phase III studies in CAP and ABSSSI ongoing.

• Will this still be head to head with ceftaroline or stall due to Novartis’ departure?


Source: PosterL1-1760 ICAAC 2010, E-1588 ICAAC 2010; DH Insight

Community Skin InfectionsCommunity Skin Infections


MRSA in Europe 2010 v 2008

2010 2008

Note change in UK due to political pressure and extra funding



Uncomplicated Skin Infections

• Large number of uncomplicated infections treated in the community.• Increasing incidence of CA-MRSA can limit treatment choices - >30% of skin

infections caused by CA-MRSA.• TMX currently is effective in the majority of cases. • Linezolid oral used for the treatment failures (~10%) – restricted by cost/AE profile.• CA-MRSA resistance patterns will change – but how quickly?p g q y

• Need for alternate oral MRSA treatments.

• All of the RTI agents mentioned could be used for uSSTI in the community.

• Will the level of methicillin resistance in S. aureus be enough to increase the

medical need and support premium pricing after loss of Zyvox patent in 2016?

• Near term - Maybe in US, unlikely in Europe.


Source: DH Insight

Novel Approaches to Serious Hospital InfectionsNovel Approaches to Serious Hospital Infections


ESKAPE – Hit List for Hospital Acquired Infections

• CDC implicates the following bacteria in 2/3rds of hospital acquired infections:

• Enterococcus spp.• Staphylococcus aureus (MSSA/MRSA)• Klebsiella spp.• Acinetobacter baumannii• Pseudomonas aeruginosa• E. coli

• This does not imply that they can not be treated with established antibiotics.


Source: www.cdc.gov, DH Insight

Hospital Post-Surgical/Invasive InfectionsImproved Infection Control Natural Decline in MRSA

• MMWR recently reported on central line acquired blood stream infections:

• ‘In 2009, an estimated 25,000 fewer CLABSIs occurred among patients in ICUs in Year 2006 2010

A Prospective, Multicenter Cohort Study of 351,617 Surgical Procedures: The Updated Epidemiology of Surgical Site Infection (SSI) in 25 Community

Hospitals in North Carolina

CLABSIs occurred among patients in ICUs in the United States than in 2001 (a 58% reduction). ‘

• ‘Given the reported mortality from CLABSIs these reductions represent an

No. Procedures n=63,071 n=71,429 P-value

Organism n (%) Rate n (%) Rate

Staph aureus 277 (29) 0 38 277 (27) 0 24 0 14CLABSIs, these reductions represent an estimated 3,000--6,000 lives saved and estimated excess health-care costs of $414 million.’‘ i ibi i i h

Staph aureus 277 (29) 0.38 277 (27) 0.24 0.14

MRSA 169 (18) 0.23 137 (13) 0.12 0.0034

MSSA 108 (11) 0.15 142 (14) 0.13 0.24

Gram negative org 223 (26) 0.35 249 (32) 0.35 0.88

• ‘Focusing on antibiotic-resistant pathogens can be especially important given the increased risk for mortality.’

org

Coag-neg Staph 108 (11) 0.15 54 (5) 0.05 <0.001

Enterococcus 90 (9) 0.12 111 (11) 0.10 0.54

• MRSA declining in community hospital setting. MSSA an increasingly important pathogen

spp 90 (9) 0.12 111 (11) 0.10 0.54


pathogen.

Source: Miller et al Poster K-477 ICAAC 2011, MMWR 4 March 2011

ESBL Driven Gram Negative Resistance Increasing• E.coli ESBL+ve continue to increase

worldwide driven by Europe and Africa.• K.pneumoniae ESBL+ve shows similar

trend, but with US incidence flat (2006 v

• Decreasing susceptibility seen in Acinetobacter spp. and ESBL+ve Enterobacteriaceae spp.

(2010).


Source: Bouchillon et al Poster 222 IDSA 2011, Hoban et al Poster 258 IDSA 2011

Carbapenemase Global Movement

NDM Resistance Pattern


Source: T Walsh ICAAC 2010

Pseudomonas & Klebsiella Carbapenem R+I in Europe 2010

Pseudomonas Klebsiella



TP-434/TP-2758 (Tetraphase)

• Novel Fluorocyclines.• Good Gram positive/negative and anaerobe spectrum.

B th t ti P d• Both not active Pseudomonas sp.• If IV + oral formulations and acceptable AE profile can be a reality, it make these agents an

interesting proposition for broad coverage of serious hospital infections.• TP-434 currently in Phase II study for cIAI.

In-vitro activity TP-434 In-vitro activity TP-2758


Source: Sutcliff J ICAAC 2011; DH Insight

Ceftaroline/Avibactam (Forest/AZ/Novexel)Fills in most of the spectrum gaps of Ceftaroline

• Novel combination gives extended spectrum to allow use against serious hospital pathogens - assuming PK profileshospital pathogens assuming PK profiles can be well matched.

• Superior activity to cefepime and imipenem monotherapy against CTX-M, plasmidic AmpC, and KPC enterobacteriaceae.

• Inherent safety of cephalosporin's and carbapenem sparing makes this ancarbapenem sparing makes this an attractive option for initial therapy in cUTI/cIAI or HAP/VAP.

• Key Issue is the positioning versus CAZ104 and CXA201.


Source: DH Insight, Dudley M IDSA 2011

CAZ104 (Novexel/AstraZeneca)• Spectrum adapted to cUTI and cIAI Organism CAZ104 CXA201• Spectrum adapted to cUTI and cIAI

infections.

• Phase II equivalent to imipenem in cUTI.

Hi t i l b t t h f NXL104

E.coli 0.254 0.251

E.coli ESBL Class A 0.08-1*2

E. coli ESBL + 0.25-1E. coli

Cephalosporin R16**5

K pneumoniae 0 54 11• Historical best match for NXL104.

• Combination is active against class A, C & D beta-lactamase producers—including KPCs.

K. pneumoniae 0.54 11

K. pneumoniae Cephalosporin R

16**5

K. pneumoniae ESBL Class A or A+C

0.5-1*2

K. pneumoniae 2*2KPCs.

• Does not cover Acinetobacter OXAs, class A VEB-1 and P. aeruginosa efflux and most ertapenem-resistant strains due to

ESBL Class CK. pneumoniae

ESBL Class A+ D1-2*2

S. marcescens 0.54 0.51

S. marcescens ESBL Class A

0.6*2

impermeability and -lactamases.

Key issues:

• Can it beat CXA201 to market for

P. mirabilis 0.124 0.251

P. mirabilis Cephalosporin R/ESBL+

0.08*2 8**5

H. influenzae 0.251

Pseudomonas 84 11

Pseudomonas

cUTI/cIAI?

• Is NXL104/aztreonam a commercially attractive combination due to NDM

?

Pseudomonas Ceftazidime S

0.253

Pseudomonas Ceftazidime R

23

Pseudomonas Imipenem R

0.53

Acinetobacter 164 321


coverage?Source:1 Brown N et al, Poster F1-1986 ICAAC 2009, 2 Levasseur P et al, Poster E186 ICAAC 2009, 3 Jacqueline C et al, Poster F1-1995 ICAAC 2009,4 Lagace-Weins P et al, Poster E-1816 ICAAC 2011, 5 Sader H et al, Poster F1-1992 ICAAC 2009, DH Insight. * Ceftazidime resistant strains, ** Cephalosporin resistant strains

Acinetobacter 16 32

ACH 490/Plazomicin (Achaogen)• Stable in face of aminoglycoside modifying

enzymes.• No current evidence of nephro- or oto-

toxicity Importantly no hearing loss (unliketoxicity. Importantly no hearing loss (unlike amikacin and gentamicin) at 14 days in guinea pig model.

• ACH-490 demonstrates good activity against most MDR RTI pathogens fromagainst most MDR RTI pathogens from countries (e.g. Greece) with high incidence of MDR pathogens.

• Synergistic with Beta-lactams for P. iaeruginosa.

• Phase II cUTI study to start in 2012.

Key Issue:Key Issue:• Will the more limited activity against

Pseudomonas and Acinetobacter restrict it only to combination therapy in all but cUTI and reduce commercial potential?


and reduce commercial potential?

Source: Badal et al Poster E131 ICAAC 2011; DH Insight

GSK2251052 (Anacor/GSK)

• Novel boron based Leucyl-tRNA Synthetase inhibitor .

• Active against Polymixin resistant Enterobacteriaceae and NDM-1 producing pathogens.

• Limited activity versus Acinetobacter and Proteus spp.

• In vivo activity against P. aeruginosa similar to gentamicin.

• Currently in Phase I studies for progression to cUTI, cIAI and HAP/VAP

Activity Versus Pseudomonas aeruginosa Global Isolatesy gDrug MIC Range MIC50 MIC90 % Sus*

GSK2251052 0.06 - 64 2 4 na

Amikacin ≤0.5 - >64 4 16 90.2Cefepime ≤0.5 - >32 4 32 75.3

Ceftazidime ≤0.5 - >32 8 >32 66.4

Colistin ≤0.25 - >8 2 8 62.3Imipenem ≤0.5 - >16 2 16 72.9

Levofloxacin ≤0.25 - >8 1 >8 63.7

Meropenem ≤0.12 - >16 0.5 16 79.3

Piperacillin/tazobactam ≤0.5 - >128 8 >128 81.3

Ticarcillin/clavulanic acid ≤4 - >128 32 >128 67.5


Source: Bouchillon et al Poster E 129 ICAAC 2011; Alley D ICAAC 2011

acid

Rx04 (Rib-X, Sanofi)• Rx04 is a novel scaffold with

activity against Gram negative pathogens.

• The whole RX-04 programme wasThe whole RX 04 programme was inspired by the discovery of the unexploited P-loop site bound by blasticidin S and TAN-1057

• Activity shown in vivo in mouse• Activity shown in vivo in mouse protection study.


Source: Posters F1-1842 to F1-1854 ICAAC 2011

MonobactamsBAL30072 (monosulfactam, Basilea)

• BAL30072 demonstrates PBP binding important for activity in P. aeruginosa and

MC1 (monocarbam, Pfizer)

Klebsiella.• Influence of Fe on uptake important in A.

baumannii.

• More active than meropenem against P. aeruginosa.

• Published spectrum does not show activity against Acinetobacter or Metallo-beta-lactamases.

• Not a substrate for purified SHV, TEM, KPC, or OXA beta-lactamases.

ff d b ffl


• Activity not affected by P. aeruginosa efflux pumps.

Source: F-2130, F-2132, F-2133 ICAAC 2010; DH Insight

BAL30072 Activity Alone or in Combination with meropenem against NDM Carrying Isolates

Organism(Number of

isolates)

MIC (mg/L)

CAZ MEM ATM SFM SFM: MEM AMK CIP TGC CST

Acinetobacter baumannii (23) >256 256 16 4 1 8 >32 4 0.75

Pseudomonas putida (3) 8 4 0.25 0.125 0.125 16 16 16 0.25

P. pseudocaligenes

(3)64 4 32 4 0.5 1 16 2 0.25

P.oryzihabitans (1) 4 2 16 1 0.5 2 0.25 4 0.25

P. aeruginosa (2) 256 32 16 0.5 <0.125 64 16 8 0.5

Stenotrophomonas maltophilia (1) 256 64 64 4 1 64 64 16 0.5

Vibrio cholerae (2) >256 8 2 32 4 8 2 0.5 8

Achromobacter 128 2 32 0 5 <0 125 16 16 0 5 0 25spp.( 3) 128 2 32 0.5 <0.125 16 16 0.5 0.25

Aeromonas caviae (2) 32 8 8 64 2 2 16 8 0.25

Escherichia coli (3) 256 32 64 32 1 4 32 4 0.5

Klebsiella pneumoniae (2) 256 128 64 32 2 64 32 8 0.25p ( )

Shigella boydii (1) 512 16 256 2 0.5 16 64 4 1

Sutonella indologenes (1) 4 4 32 0.5 0.25 2 0.25 8 2

Citrobacter freundii (3) 128 128 64 8 2 64 32 2 0.5


Source: Walsh et al Poster E722 ICAAC 2011

ME1070 B-lactamase inhibitor (Meiji Seika)

• ME1071, a maleic acid derivative, is a novel specific inhibitor for metallo-β-lactamases (MBL). In vitro, ME1071 has the inhibitory activity to MBL producing P aeruginosaactivity to MBL producing P. aeruginosa

• Clinical efficacy of ME1071 against ventilator-associated pneumonia (VAP) caused by MBL-producing P.aeruginosa, was

fi d i d l i i kiconfirmed using a mouse model mimicking VAP by placement of a plastic tube in the bronchus.

• Histopathological examination of lung specimens indicated that the combination group prevented the progression of lung inflammation.

Protection of Carbapenems by ME1071 Against Metallo-β-Lactamase-Producing Enterobacteriaceae

Geometric mean MIC mg/LBiapenem Doripenem Imipenem Meropenem

ME1071 - + - + - + - +IMP 3.1 0.14 18.4 0.16 13.0 0.78 13.5 0.14VIM 3.6 0.34 7.5 0.32 24.3 2.1 8.2 0.25

Insight Briefing – Antibiotics 7th December 2011© Defined Health 2011 © Defined Health 2011

Source: Hope et al Poster F1-150 ICAAC 2011, Yanagihara et al Poster F1-151 ICAAC 2011

NDM 7.7 3.0 68.6 36.7 42.2 21.1 84.5 45.3

Narrow Spectrum agents - FabI Inhibitors

• Novel FabI inhibitors are under development by FAB Pharma (MUT056399) and Affinium (AP-1252).

• Narrow spectrum Staphylococcus sp. only. Low MIC’s against MDR Staph species.

• Potential for IV and oral formulations.C ti i f i (1 h ) d hi h t i bi di (MUT056399 95%)• Continuous infusion (1 hour) and high protein binding (MUT056399 - 95%) may make dosing problematical.

Key Issues:Key Issues:• Need for rapid ‘point of care’ test to allow early inclusion in treatment pathway.• Place in therapy as an alternative to glycopeptides/cephalosporins?


Source: DH Insight

AFN-1252 - Affinium

Activity of AFN-1252, a FabI Inhibitor with Potent Activity against S. aureus (SA) and Coagulase-Negative Staphylococcus spp. (CoNS), Including Multidrug-Resistant Strains

No. (cum. %) of isolates inhibited at AFN-1252 MIC (µg/ml)

Species (no. tested) 0.002 0.004 0.008 0.015 0.03 0.06 0.12 0.25 0.5

S. aureus(471) 4 (0.9) 297 (63.9) 142 (94.1) 9 (96.0) 6 (97.2) 11 (99.6) 2 (100.0) - -

MSSA (154) 2 (1.3) 88 (58.4) 48 (89.6) 0 (89.6) 6 (93.5) 9 (99.4) 1 (100.0) - -

MRSA (163) 1 (0.6) 102 (63.2) 52 (95.1) 8 (100.0) - - - - -

MC-MRSA (154) 1 (0.7) 107 (70.1) 42 (97.4) 1 (98.1) 0 (98.1) 2 (99.4) 1 (100.0) - -

CoNS (103) 0 (0.0) 4 (3.9) 23 (26.2) 28 (53.4) 20 (72.8) 12 (84.5) 12 (96.1) 3 (99.0) 1 (100.0)


Source: Biedenbach et al Poster F1-1348 ICAAC 2011

MUT056399 – FAB Pharma

Drug Community acquired(n=127) Hospital acquired(n=40) hVISA+VISA+VRSA (n=33)

Antistaphylococcal Activity of MUT056399, a New FabI Inhibitor

Drug Community-acquired(n=127) Hospital-acquired(n=40) hVISA+VISA+VRSA (n=33)

Range MIC50 MIC90 Range MIC50 MIC90 Range MIC50 MIC90

MUT056399 0 03 8 0 03 0 03 0 016 8 0 06 0 06 0 016 4 0 03 1MUT056399 0.03-8 0.03 0.03 0.016-8 0.06 0.06 0.016-4 0.03 1

Vancomycin 1-2 1 1 1-2 1 2 1->128 4 128

Linezolid 1-2 2 2 1-4 2 2 ≤0.5-2 2 2

Daptomycin 0.25-0.5 0.25 0.5 0.25-2 0.25 0.5 0.25-8 1 2

Quinu/Dalfo 0.25-0.5 0.5 0.5 0.12-1 0.5 1 0.12-2 0.5 0.5


Source: Todd et al Poster F1-2011 ICAAC 2009

Novel Approaches to BiofilmsNovel Approaches to Biofilms


Biofilms• Biofilm formation represents a challenge to treatment with conventional antimicrobial

therapy as bacteria are not only protected by a viscous coat, but they also alter their form rendering them protected from the majority of antimicrobials.

• The period shedding of planktonic organisms is characteristic of catheter or other deviceThe period shedding of planktonic organisms is characteristic of catheter or other device related blood stream infections.

• A variety of novel approaches are being investigated:• The use of biologically active or inactive adjuvants from marine sources to enhance the

f bactivity of current antibiotics. • SYN01, a novel chitosan derivative, effectively dissolves biofilms and maintains broad antibiotic

activity including Pseudomonas aeruginosa. • OligoG an alginate oligimer.

• Peptides and other molecules from marine based flora, that may have intrinsic cidal activity on the target pathogens or can prevent biofilm formation

• Development of novel molecules able to disrupt stationary phase bacteria in biofilms • MBX-1162, a Bis-Amidine, decreased CFU/ml by 10,000 and 100,000-fold within 4 h at , , / y , ,

concentrations equivalent to 1x MIC (0.25 µg/ml) and 4x MIC (1 µg/ml). It was however not active against mature S.aureus biofilms.

• Novel uses of electricity • Low amperage current (as low as 2µA) to disrupt biofilms of Pseudomonas, S. Aureus.


p g ( µ ) p ,• Spark based non-thermal plasma disruption of biofilms.

Source: Worthington Poster E1- 1827 ICAAC 2011, Opperman F1-156 ICAAC 2011, Greenwood-Quaintance Poster F2-171 ICAAC 2011, Khan Poster F1-154 ICAAC 2011, Ferrell F2-168 ICAAC 2011

Clostridium difficileClostridium difficile


C. difficile• The launch of fidaxomicin raises the question as to the required minimum profile of another

small molecule approach for C.difficile infections (CDI’s) .• The publication in 2010 of the Phase II results for the Merck monoclonal antibodies in

combination with vancomycin showing a 7% relapse rate further raises the bar for futurecombination with vancomycin showing a 7% relapse rate further raises the bar for future molecules/approaches if this can be replicated in the registration studies.

• At present the only proven approach for patients with multiple recurrent CDI’s is faecal replacement!

h h f l l l b k d h d l ?• So what are the opportunities for novel molecules – between a rock and a hard place?• First line treatment would seem to be difficult to capture. The efficacy of inexpensive generic

vancomycin/metronidazole in patients with an initial CDI is about 90%. • Fidaxomicin has shown significant reductions in recurrence in all but the hypervirulent NAP1/BI/027 strain.

H th d i t t i t ti d i E th 076 t i i thHowever the dominant strains present vary over time and as we see in Europe the 076 strain is now the more important clinically than 027.

• The mAb approach and the vaccine (Acambis/Sanofi-Pasteur) have the potential to reduce the number of patients needing to receive multiple courses of treatment for CDI.

• It is assumed that the pricing of the mAb will be in excess of the $2 800/course for fidaxomicin and that the• It is assumed that the pricing of the mAb will be in excess of the $2,800/course for fidaxomicin, and that the vaccine may only be used on high risk patients coming to hospital for elective procedures or in patients who have had an initial CDI.

• So future near to mid-term battles will take place trying to secure the endorsement as ‘treatment of choice’ to displace fidaxomicin/mAbs Fine until the better ‘mouse trap’ comes


treatment of choice to displace fidaxomicin/mAbs. Fine until the better mouse trap comes along.

Source: DH Insight

Where else to look for Alternate Approaches?Where else to look for Alternate Approaches?


Where to look? Alternate Approaches?

Where to look?• Antarctica is the source of a compounds for Piramal Life Sci. Limited – novel

Streptomyces species.

Some Alternate approaches• Defensin mimetics: PMX30063 (PolyMedix) with a Gram positive focused spectrum

of activity, currently in Phase II.• Novel peptides: LTX-109 (Lytix) able to lyse bacterial cells – topical applications in

Phase IPhase I.• RecA inhibitors (Synereca) adjuvant therapies to enhance the activity of current

antibiotics.• Arenicin-3 (Adenium Biotech) focus on Gram negative pathogensArenicin 3 (Adenium Biotech) focus on Gram negative pathogens.


Source: DH Insight

Conclusions

Will we get 10 x 2020?• There will be some new agents available by 2020 – how many and in which area is

difficult to say.

What are the key take-aways?• Gram negative infections will remain a key focus for the next decade.g y• Infection control measures will reduce the number of infections in some areas –

e.g. blood stream infections.• But the aging population and the increasingly compromised patient population

undergoing surgical procedures will still pose questions for treatment of infections.• Community pathogens will change over time. CA-MRSA may be a big driver of

future community focused revenue when it becomes resistant to current first-line antibiotics Community RTI’s may be of interest if CA MRSA grows in prevalenceantibiotics. Community RTI s may be of interest if CA-MRSA grows in prevalence.

• Product differentiation within the hospital will focus on the ‘Broad Spectrum’ approach of the 5GC’s and tetracycline analogues, with the Monobactams and other new classes plus novel β-lactamase inhibitors being used exclusively for MDR


p β g ypathogens.

Source: DH Insight

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