Antibacterial Drugs: The Last Frontier.

Our pipeline of antibacterial drugs is woefully lacking in our most high priority areas of medical need. In the absence of a reasonable return on their investment in antibacterial drugs, large companies have, for the most part, abandoned the area. Private investment in the research and development of these agents is plummeting, and public support, while important, cannot entirely replace this loss. Small companies have replaced the large ones in providing pipeline compounds. They are more susceptible to financial strain leading to the very real risk of bankruptcy as recently demonstrated by Achaogen and Melinta. I recommend taking three steps to ameliorate this impending crisis. We should provide financial support for the market preferably through a market entry reward or transferable exclusivity vouchers. To achieve this goal, we need to aggressively recruit professionals and patients to our cause who have been or will be affected by a lack of effective antibacterials. Our expert infectious disease societies must provide more timely clinical guidelines for therapy of resistant infections such that recently approved drugs will be used when indicated. We need regulation or legislation requiring manufacturers of antibacterial susceptibility testing devices to provide the ability to test new drugs in a timely manner.