title: An assessment of the future impact of alternative technologies on antibiotics markets.
abstract: BACKGROUND
  The increasing threat of antimicrobial resistance combined with the paucity of new classes of antibiotics represents a serious public health challenge. New treatment technologies could, in theory, have a significant impact on the future use of traditional antibiotics, be it by facilitating rational and responsible use or by product substitution in the existing antibiotics markets, including by reducing the incidence of bacterial infections through preventative approaches. The aim of this paper is to assess the potential of alternative technologies in reducing clinical use of and demand for antibiotics, and to briefly indicate which segments of the antibiotics market that might be impacted by these technologies.
  
  
  METHODS
  An initial mapping exercise to identify the alternative technologies was followed by a review of relevant published and grey literature (n= 52). We also carried out stakeholder engagement activities by a round-table discussion with infectious disease specialists and a multi-criteria decision analysis exercise with pharmaceutical industry experts.
  
  
  RESULTS
  Ten alternative technologies were identified and analyzed for their potential impact on the antibiotics market. Of these, rapid point-of-care diagnostics, vaccines, fecal microbiota transplantation, and probiotics were considered to have a "high" or "medium" potential impact over a 10-20 year horizon. Therapeutic antibodies, antibiotic biomaterials, bacteriophages, antimicrobial nanoparticles, antimicrobial peptides, and anti-virulence materials were rated as having "low" potential impact.
  
  
  CONCLUSIONS
  Despite the apparent potential of the most promising alternative technologies to reduce demand, that reduction will likely only happen in limited segments of the antibiotics market or, in the case of preventing community acquired streptococcal infections by vaccination, in a low-price generics market segment. Thus, alternative technologies are not expected to represent any disincentive to antibiotics developers. Finally, it is unlikely that alternative technologies will displace the need for new classes, and sub-classes, of antibiotics in the short and medium terms.
authors: Norwegian Institute of Public Health, Oslo, Norway.
authors: Ejike
authors: E
authors: Nwokoro
authors: Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors: Ross
authors: R
authors: Leach
authors: Norwegian Institute of Public Health, Oslo, Norway.
authors: Christine
authors: C
authors: Årdal
authors: Uppsala University, Uppsala, Sweden.
authors: Enrico
authors: E
authors: Baraldi
authors: AstraZeneca, Gaithersburg, MD USA.
authors: Kellie
authors: K
authors: Ryan
authors: Norwegian Institute of Public Health, Oslo, Norway.
authors: Jens
authors: 0000-0003-3115-0389
authors: J
authors: Plahte