Asger Risom
A major pharmaceutical firm’s discontinuation of the reserve antibiotic Recarbrio highlights a catastrophic flaw in healthcare economics: drugs designed to cure the world’s most dangerous superbugs simply do not make enough money to survive.
In any other industry, creating a highly effective, lifesaving product guarantees commercial success. But the pharmaceutical market for superbug treatments operates on a broken economic paradox: the more critical a new antibiotic is to global public health, the less money it is allowed to make.
Welltica reports that a major pharmaceutical firm has officially discontinued Recarbrio from the U.S. market, seven years after it received FDA approval. The withdrawal removes a critical, three-drug injection—combining imipenem, cilastatin, and the newer relebactam—designed specifically to treat patients with highly complicated, drug-resistant infections, including ventilator-associated pneumonia.
The company behind the withdrawal is Merck, the American multinational pharmaceutical giant that historically played a foundational role in bringing commercial antibiotics to the masses. Merck’s exit from the Recarbrio market is not a medical failure; it is a structural economic failure. It exposes the fatal flaw in how the global healthcare system funds antibiotic development.
The paradox of reserve antibiotics
Recarbrio was classified by health authorities as a “reserve antibiotic.” To prevent pathogens from mutating and developing resistance, doctors are instructed to use these drugs only as an absolute last resort when older, cheaper antibiotics fail.
From a public health perspective, this strict stewardship is essential. From a corporate finance perspective, it is disastrous. Pharmaceutical companies spend billions developing these compounds, only for hospitals to lock them in a glass cabinet and intentionally avoid using them. With sales volumes artificially restricted by design, the commercial potential of novel antibiotics is fundamentally crippled. Following the withdrawal of Recarbrio, Merck is left with only mature antibiotics in its portfolio and zero new antibacterial programs in late-stage development.
A broader industry exodus
Merck is far from the first pharmaceutical giant to retreat from the front lines of the superbug crisis. The modern history of antibiotic development is littered with corporate exits and high-profile bankruptcies.
In 2018, both Novartis and Sanofi announced they were shuttering their antibacterial and antiviral research programs to focus on more lucrative fields like oncology.
The market dynamics are so hostile that even successful innovation is punished. In 2018, a California biotech startup named Achaogen achieved what many considered impossible: it successfully developed and secured FDA approval for Zemdri, a powerful new antibiotic targeting complicated urinary tract infections. But because Zemdri was heavily restricted as a reserve drug, Achaogen could not generate enough revenue to sustain its operations. Less than a year after getting FDA approval, the company filed for Chapter 11 bankruptcy.
A rising global death toll
This mass corporate exodus is colliding directly with a rapidly escalating global health crisis. According to the World Health Organization, antimicrobial resistance (AMR) was linked to more than 4.7 million deaths globally in 2021. By 2023, the WHO estimated that one in six laboratory-confirmed bacterial infections was completely resistant to standard treatments.
The crisis is deeply entrenched in Europe as well. The European Centre for Disease Prevention and Control (ECDC) tracks roughly 35,000 deaths annually across the EU and EEA directly attributable to antibiotic-resistant infections. Even in Denmark, which historically boasts some of the lowest antibiotic consumption rates in agriculture and healthcare, the Statens Serum Institut (SSI) warns that systemic consumption is climbing unchecked, directly fueling the rise of dangerous pathogens like MRSA and carbapenemase-producing organisms (CPO).
Because the pharmaceutical pipeline for new reserve antibiotics has effectively dried up, health institutions are pivoting to aggressive demand-side stewardship. The SSI’s official institutional guidance now strictly instructs the public to adhere to prescribed courses, cease hoarding leftover pills, and only consume antibiotics when explicitly deemed necessary by a physician.
When the financial markets refuse to fund the development of new weapons, the only remaining strategy is rationing the few that still work.
