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Portfolio analysis

Antimicrobial portfolios: what medicines are on the market?

Antimicrobials must be used conservatively to preserve their useful lifespan. However, many people live without access to the antimicrobials they need, including for malaria, tuberculosis and many bacterial infections.¹ The 2018 AMR Benchmark examined the portfolios of 30 pharmaceutical companies to establish how many antimicrobial medicines were currently on the market and in need of access and stewardship strategies.

The companies in scope have at least 741 antimicrobial medicines on the market – more than half of which (454) target bacterial infections. Resistance to different products emerges at different rates, with some products already being less effective.

Figure 16. Which antimicrobial medicines are available on the market?
Per product, it is critical that pharmaceutical companies, governments, donors and other stakeholders integrate and expand plans for conserving the effectiveness of antimicrobials on the market, while also increasing people’s ability to access antimicrobials when they need them.

Breakdown: 741 antimicrobials into 5 categories

In this analysis, the antimicrobials are grouped into five categories: antiprotozoals, which target parasites including malaria; antihelminthics, which target parasitic worms called helminths; antivirals, antifungal medicines, and antibiotics. Antibiotics are by far the largest category, followed by antivirals. 

88 Antiprotozoals 

24 Antiamoebic and antigiardiasis medicines
6 Antileishmaniasis medicines
45 Antimalarial medicines
Antipneumocystosis and antitoxoplasmosis medicines
0 Antitrypanosomal medicines
4 Multiple categories 

Out of 88 antiprotozoals, 45 target malaria, including some older products that are redundant due to AMR. Most countries now rely on artemisinin-based antimalarials. Stewardship of these medicines and R&D into replacements is critical. Other antiprotozoals target NTDs, such as leishmaniasis for which treatment is available but not widely accessible.

177 Antivirals 

24 Antiherpes medicines
114 Antiretrovirals
Other antivirals
21 Antihepatitis medicines
12 Multiple categories

Out of 177 antivirals, most are antiretroviral therapies (ART) for HIV/AIDS. In 2010, almost 7% of people receiving ART had drug-resistant HIV. Increased use of ART will likely increase resistance. This analysis includes 61 fixed-dose ART combinations, which reduce the pill burden for patients, improving patient adherence and limiting resistance. New Direct Acting Antivirals for hepatitis C have shorter treatment regimens which also improve patient adherence.

13 Anthelminthics

1.5 billion people are infected with helminths,such as threadworms.³ A sharp increase in anthelminthic resistance in livestock has raised concerns over the development of resistance in human helminths. Some countries have now restricted anthelminthics to prescription use only. In the last 30 years, only one new anthelminthic has been introduced. ⁴

7 Intestinal anthelminthics
0 Antifilarials
2 Antischistosomals and other antitrematode medicines
4 Multiple categories

454 Antibacterials

More than half the products in the portfolio are antibacterials, including 189 beta-lactams. These remain important antibiotics for their broad-spectrum effectiveness. Ensuring access to these is a public health priority. A further 55 antibacterials target tuberculosis (TB). There has only been one new TB medicine introduced in 40 years. Stewardship of this medicine is being managed in national TB programmes.⁵

189 Beta-lactam antibacterials
180 Other antibacterials
    1 Antileprosy medicines
  55 Antituberculosis medicines
  29 Multiple categories

50 Antifungal medicines

Fungal infections now cause more deaths than malaria or tuberculosis. Resistance to antifungals has been described for almost all fungal pathogens including Candida.⁶ However, fewer than 10 national surveillance programmes have been developed to monitor the resistance trends of fungal infections.⁷

For a full list of references, please see the 2018 AMR Benchmark report.

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