This entry is based on the following paper:

<aside> 📄 Outterson K, Orubu ESF, Rex J, Årdal C, Zaman MH. Patient Access in 14 High-Income Countries to New Antibacterials Approved by the US Food and Drug Administration, European Medicines Agency, Japanese Pharmaceuticals and Medical Devices Agency, or Health Canada, 2010-2020. Clin Infect Dis. 2022 Apr 9;74(7):1183-1190. doi: 10.1093/cid/ciab612. PMID: 34251436; PMCID: PMC8994582.

</aside>

The reason this is important

Evolution of carbapenemases alongside carbapenems:

Taken from this tweet here.

AMR is a rising problem in LMICs, and is disproportionately (~70%) related to beta lactams and quinolones.

Availability of new antimicrobials

Taken from this tweet from @bradspellberg:

NB: Green = meets unmet need; Yellow = sorta maybe has some use; Red = does not address unmet need

So: So in summary we have since 2009 approved the following:

• Gram positive (MRSA, VRE etc):

  • Tela/Dalba/Oritavancin
  • Ceftaroline/Ceftobiprole
  • Tedizolid
  • Delafloxacin
  • Omadacycline
  • Lefamulin

• TB (not discussed further)

  • Bedaquiline
  • Pretomanid

• Gram negative (ESBL, CRE):

  • Beta-lactam +/- BLI:
    • Pseudomonas: Ceftolozane-Tazobactam, ?Ceftobiprole?
    • CRAB: Sulbactam-durlobactam
    • Ceftazidime-avibactam
    • Meropenem-vaborbactam
    • Imipenem-cilastatin-relebactam
    • Cefepime-enmetazobactam
    • Cefiderocol THE TROJAN HORSE
  • Non-beta lactams:
    • Eravacycline
    • Plazomicin (discussed previously)

So for G+ we have:

• 3 long-acting glycopeptides
• 2 beta-lactams
• A linezolid clone, a quinolone, a tetracycline & a pleuromutilin (google it)

And for G- we have:

• 1 Beta lactam
• 7 BL/BLIs
• 1 trojan horse
• A tetracycline & an aminoglycoside.

So who can access these antibiotics?

Figure 1 from the above paper:

Country: of 18 drugs approved worldwide:

• 17 available in US (Lascufloxacin only launched in Japan)
• 14 in EU (No Lascufloxacin, Omadacycline, Sarecycline, Plazomicin)
• 11 UK (as per EU, plus no Lefamulin, Eravacycline, Oritavancin)
• Of the other G7 countries:
  • France has access to 8
  • Italy & Germany: 7
  • Japan: 5
  • Canada: 2! (Ceftolozane-tazobactam, Fidaxomicin)

Drug: Availability out of 14 countries studied:

• Available in 14: Fidaxomicin, Ceftolozane-tazobactam
• 12: Ceftaroline, Tedizolid, Ceftazidime/avibactam
• 10: Dalbavancin
• 9: Bezlotuximab
• 2-9: Cefiderocol, Imipenem/relebactam, Meropenem/vaborbactam, Delafloxacin
• 1: Lascufloxacin (Japan), Lefamulin, Omadacycline, Seracycline, Eravacycline, Plazomicin, Oritavancin

Note re: the 4 drugs not approved in the EMA: