The market shuffles, the compound cephalosporin remains the king! The growth rate of one variety and two specifications exceeds 160%

Since the promulgation of the most stringent antibiotic management measures (commonly known as order 38) in 2011, bacterial drug resistance has entered the field of vision and rapidly become a hot spot The national health and Family Planning Commission issued the first antimicrobial policy document in 2017, namely the notice of the general office of the national health and Family Planning Commission on Further Strengthening the clinical application management of antimicrobial drugs to curb bacterial drug resistance (hereinafter referred to as the notice), which is worthy of our careful re examination of the changes in the relevant demand trend According to the sample market data (provided by Shanghai Pharmaceutical Industry Information Center), the market of anti infective drugs has been significantly reduced since 2011, then gradually recovered, the market grew slowly, and it recovered to the highest level in 2010 in 2013, and then continued to grow every year, reaching a new high of 25.1 billion yuan in 2016 In 2010, compared with 2016, cephalosporin was still the first category in the anti infection market, but the absolute value increased little and the share decreased significantly It shows that the anti infection market is an absolute rigid demand, and the demand diversification presents three major characteristics: more complications (especially fungus flooding after flora disorder), more bacterial resistance (high-speed growth of carbapenems, vancomycin and tegacyclin), and more new treatment methods These three diversities have become the main driving force for the growth of anti infective drugs in 2011-2016 From 2005 to 2016, the sales volume of various small categories of anti infective drugs decreased As the cephalosporins with the largest market share of anti infective drugs, the number of anti infective drugs decreased generally, showing an alternative style In terms of sales composition, the quantity of cephalosporins has declined significantly in the past five years Changes of active drug specifications in sample market from 2012 to 2016 Among the anti infective drugs, except for a few small groups, the number of product specifications (the number of registration certificates) has increased or basically remained the same, most small groups have decreased in varying degrees, and the number of polypeptides, anti fungi, anti hepatitis virus and other lactams (mainly carbapenems) is basically the same The average output of product planning has increased significantly, but most of them are products of foreign enterprises The trend of cephalosporins remaining as the king is obvious Although the overall capacity has not increased significantly, the output of single product has increased due to the obvious decline in the number of product specifications Other lactam antibiotics (carbapenems) will influence each other in the future because of their close antibacterial spectrum In recent years, due to the rapid development of clinical treatment, extensive and unreasonable use of antibiotics, the negative effects of strict control of carbapenems are the increase of nosocomial infection rate and drug-resistant strains, the continuous increase of bacterial resistance, leading to clinical treatment failure, infection recurrence, increased risk of death, etc The notice aims to ensure the best use of antibiotics to resist the development of drug resistance The core point is to strengthen the management of carbapenems and other special class antibacterial drugs Specifically, the following points deserve attention, including: 1) the supply catalogue of antibacterial drugs requires that "the injection type of carbapenem antibacterial drugs shall be strictly controlled within 3 product specifications" 2) emphasize "strengthen the management of carbapenem and tegacyclin and other special use level antibacterial drugs", especially for the special use level antibacterial drugs, strictly implement the prescription right restriction and consultation system, and the use of the prescription shall not exceed 1 day in case of emergency 3) it is emphasized that special use level antibiotics should not be used in the outpatient department, and the rate of microbial test before the use of special use level antibiotics in inpatients should not be less than 80%; 4) special use level antibiotics such as carbapenem and tegacyclin should be managed in advance: information should be filled in for clinical use, and collected and analyzed regularly It can be clearly seen that in recent years, carbapenems and other antibacterial drugs, which are known as the "last line of defense" in the field of clinical moderate and severe infections, will be strictly approved by the state and used for indications The traditional empirical antibacterial treatment of these drugs will be limited, which will have a significant impact on the market trend of carbapenems in the later stage In addition, the more stringent is the restriction clause added in the 2017 version of the medical insurance catalog, which clearly stipulates that carbapenems basically need to have drug sensitivity test evidence Because the drug sensitivity test has a certain cost and cycle, it will greatly challenge the existing clinical medication routine The growth of carbapenems is likely to be unsustainable Compound cephalosporins take advantage of the market share, then, due to the impact of policy, who will fill the market share of carbapenems? There is no doubt that carbapenems are facing market difficulties The compound cephalosporins, which belong to β - lactams with carbapenems, will benefit the most when their competitors are restricted First of all, in the aspect of anti infective treatment, both compound cephalosporins and carbapenems belong to broad-spectrum antibiotics, especially the stability of compound cephalosporins after adding β - lactamase inhibitors is equivalent to carbapenems, and it is even better than the latter in the aspect of MDR, especially in the aspect of drug resistance rate It is aimed at Acinetobacter baumannii, a colonizing bacterium with increasing nosocomial infection The drug resistance rate of the third generation cephalosporin compound preparation is 49%, which is significantly lower than that of carbapenems In the overall market of cephalosporins, the growth of compound cephalosporins is slightly faster, and the market share is significantly expanded The cumulative growth of compound cephalosporins of the third generation and the fourth generation is the largest In terms of the active product size of anti infective drugs in the past five years, except for the growth of a few categories (such as anti AIDS drugs, anti influenza, etc.), other categories are flat or slightly down (such as cephalosporin, penicillin, etc.) Cephalosporin, penicillin and other mainstream products show the trend of "the leftover is the king" While the number of product specifications is decreasing, the total market share is slowly rising In the third generation of cephalosporins, the number of product specifications in 2016 decreased by 30.5% compared with that in 2012 Combined with the growth of sales, the trend that the remaining is the king is more and more obvious However, cefotaxime + sulbactam 1.5g accounted for about 90% of the mainstream varieties in the whole sample market, with a rapid growth in recent years The compound growth rate from 2012 to 2016 reached 168.20%, becoming the fastest-growing product among the three generations of compound cephalosporins, with huge market potential Market share of compound third generation cephalosporins in 2016