However, the development of antibacterials has become increasingly unattractive to big pharma for a number of reasons: short antibacterial drug lifecycles; the fact that antibacterial therapy is acute, not chronic; the mature nature of the market, which is characterized by low growth and high generic penetration; and the raising of the bar for the statistical standards needed to show the efficacy of experimental drugs in clinical trials. A key factor contributing to shorter drug lifecycles is bacterial resistance. Shorter lifecycles increases the risk to drug developers (as they have less time to recoup their R&D investments); restricts sales growth (as many governments have introduced schemes to limit antibiotic use to combat resistance issues such as methicillin-resistant Staphylococcus aureus (MRSA)); and prioritizes the need for intensive lifecycle-management strategies (for example, developing an extended-release formulation).

All of these factors have led to the overriding view that big companies can spend their research dollars in more productive ways. Although the market size is significant, with an estimated total sales of US$25.5 billion in 20051, 10 out of the 15 largest companies have fully abandoned, or cut down significantly, their discovery efforts in this field since 19992. Smaller firms (such as Basilea, Theravance and Cubist) have been taking over the drug development role, both by identifying innovative drugs or formulations, and/or by picking up clinical programmes aborted by the larger companies. However, big pharma often becomes involved later through in-licensing later-stage pipeline drugs, as a strong salesforce is key to success in the community antibacterials market.

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