The drug market for key hospital-treated infections will increase from a value of $3.3 billion in 2010 to just over $4 billion in 2020 in seven major world markets, according to new forecasts.

Sales are set to increase in this market despite constraints which include intensified competition, generic erosion and an increasingly stringent regulatory environment in these seven markets - the US, France, Germany, Italy, Span, the UK and Japan, says the report, from Decision Resources.

The uptake of eight new therapies, as well as Forest/AstraZeneca/Dainippon Sumitomo's anti-methicillin-resistant staphylococcus aureus (MRSA) drug Teflaro (ceftaroline fosamil), will also help offset sales losses and will account for 30% of sales in these major markets in 2020, it adds.

Up to 2020, generic erosion of nine key branded products - most notably Pfizer's Zyvox (linezolid) - will be a major constraint to growth, says the study, which also notes that, although the market is currently dominated by parenteral agents, drug developers have recognised a long-standing need for agents that are available in an interchangeable intravenous and oral formulation, and several such agents are poised to launch over the next decade.

These include tedizolid, Trius Therapeutics' intravenous and oral oxazolidine product, which is forecast to achieve sales close to $400 million by 2020. This product's uptake will be due to its activity against gram-positive pathogens including MRSA, its reduced toxicity compared with Zyvox and its availability as a step-down therapy, says Decision Resources.

Hospital-treated infections of particular interest to the industry include nosocomial pneumonia, bloodstream infections, skin and skin structure/surgical site infections and urinary tract infections, notes the report.  Other key emerging agents, in addition to Teflaro and tedizolid, include two anti-MRSA quinolones - Rib-X/Sanofi's delafloxacin and Furiex' JNJ-Q2 - plus two anti-MRSA glycolipopeptides with long half-lives - Durata Therapeutics' dalbavancin and The Medicines Company's oritavancin.

Additionally, two beta lactam/beta lactamase inhibitor combinations - Cubist's CXA-201 and AstraZeneca/Forest's CAZ-AVI - will also launch within the next 10 years, forecasts the study, whch notes that these combinations are notable because they are active against multi-drug-resistant gram-negative pathogens, including Pseudomonus aeruginosa.

However, the report's authors believe that Teflaro is best poised for commercial success because of its early market entry, significant improvements in spectrum and dosing frequency over currently-marketed cephalosporins and its favourable price compared with current anti-MRSA agencies such as Cubist's Cubicin (daptomycin), Theravance/Astellas' Vibativ (telavacin) and Pfizer's Zyvox.

The study findings also reveal that increasing competition in the already-overcrowded drug market for hospital-treated infections means that emerging agents will face bigger challenges to gain formulary inclusion and will need to demonstrate clear differentiation from their competitors.

"Additionally, the use of new therapies in the hospital setting will likely be monitored more carefully, owing to the increased emphasis on antibiotic surveillance and stewardship programmes," forecasts Decision Resources analyst David Holman.

"Nonetheless, we expect hospital-treated infections to remain a key segment of the overall antibiotics market, due to the increasing prevalence of multidrug-resistant infections, as well as an ageing population who are at increased risk of developing serious infections that require hospital treatment,” he adds.