Abstract
Antimicrobial resistance is a pressing global threat, but companies developing antibiotics are failing. Large pharmaceutical companies recently created the AMR Action Fund, which will invest $1 billion in small antibiotic development companies. To understand the state of antibiotic development in the United States, we conducted a case study of new agents against carbapenem-resistant Gram-negative bacteria. Factors contributing to market failures were slow clinical uptake of drugs despite their effectiveness and safety, relatively small numbers of target infections that are insufficient to support existing drugs economically, and an excess of recently approved and pipeline agents with redundant spectra of activity. The AMR Action Fund will provide an immediate lifeline to companies in danger of failing due to an inability to secure investment, but it will not address issues identified in the case study or fix the antibiotic development model or marketplace. The Fund buys time for reforms to salvage antibiotic development.