Stakeholder Opinions: Urinary Tract Infections Growing resistance rates bring opportunities for both new and old drugs

Table of Contents

EXECUTIVE SUMMARY

• Scope of the analysis
• Datamonitor insight into the urinary tract infections market
• Contributing experts
• Related reports
• Upcoming related reports

EPIDEMIOLOGY AND DISEASE BACKGROUND

• Etiology and symptoms
  • Types of urinary tract infections
  • Complicated and uncomplicated urinary tract infections
  • Pathogens
  • Risk groups

• Epidemiological trends
  • 150 million estimated cases of urinary tract infection worldwide each year
  • US
  • Europe
  • UK
  • Germany
  • France
  • Italy
  • No incidence data have been published for Japan or Spain

• Economic burden of urinary tract infections
  • US expenditure on urinary tract infection up by 30% between 1994 and 2000

PRESENTATION, DIAGNOSIS AND REFERRAL OPTIONS

• Overview
• Presentation
• Diagnosis
  • Urine culture is the gold standard in the diagnosis, although most physicians rely on the presence of risk factors and/or dipstick testing
  • Guidelines for the diagnosis and management of urinary tract infections are targeted at physicians across the seven major markets
  • Physicians have different perceptions of the level of bacteriuria that is clinically significant
  • Cost and time to results limits the use of urine culture to complicated urinary tract infection cases only

• Referral
  • Primary care physicians treat most urinary tract infections, although a referral may be made in complicated or recurrent cases
  • Suggestion of complicated urinary tract infection or an underlying urologic problem typically lead to hospitalization
  • Nosocomial urinary tract infections are treated by the attending physician
  • US organizations are working to educate both patients and physicians on urinary tract infections

CURRENT TREATMENT OPTIONS AND TRENDS

• Market overview
• Treatment guidelines
• Treatment options
  • Penicillins
  • Fluoroquinolones
  • Trimethoprim products
  • Carbapenems
  • Older drugs
  • FDA notification of tendinitis and tendon rupture risk for fluoroquinolones

• Resistance of bacterial pathogens to urinary tract infection therapies
  • Growing levels of bacterial resistance have rendered a number of leading urinary tract infection drugs ineffective in many regions
  • Increasing fluoroquinolone resistance threatens effectiveness of therapies and future treatment choices
  • Susceptibility and resistance data suggests more prominent future roles for nitrofurantoin and fosfomycin
  • Emerging pathogens

• Treatment choice
  • Efficacy against pathogens is highly influential in treatment choice for urinary tract infections, although safety and cost also play a role
  • Treatment by site of infection

UNMET NEEDS AND NEW DEVELOPMENTS

• Recently approved therapies and drugs in development for urinary tract infections
  • New drug approvals for uncomplicated urinary tract infections have been sparse over the past 5 years as the impact of generics grows
  • Pipeline drugs in late-stage development

• Unmet needs and future developments
  • Treatment satisfaction
  • Unmet needs in the diagnosis of urinary tract infections
  • Unmet needs in the treatment of urinary tract infections

• Future developments
  • Researchers at UCLA are developing point-of-care technology for the detection of urinary tract bacterial pathogens
  • US researchers have recently suggested strategies for developing new virulence-targeted urinary tract infection therapies

BIBLIOGRAPHY

• Journal papers
• Websites
• Other

APPENDIX A

• Contributing experts

APPENDIX B

TABLES

• Table: Pathogens responsible for urinary tract infections in the community and hospital setting
• Table: Pathogens isolated most frequently among community outpatients with a urinary tract infection in Brescia, Italy, 2002 - 05
• Table: Pathogens isolated from urine of patients with a catheter-associated urinary tract infection in Brescia, Italy, 2002 - 05
• Table: Pathogens most frequently isolated among hospital inpatients with a urinary tract infection in Brescia, Italy
• Table: Estimated number of visits to physicians for UTI in the US, 2000
• Table: Number of physician visits for urinary tract infection (site not specified) in the US, 1995 - 2006
• Table: Number of physician visits for cystitis and other disorders of the bladder in the US, 1995 - 2006
• Table: Number of physician visits for urinary tract infection (site not specified) and cystitis and other bladder disorders in the US, 1995 - 2006
• Table: Annual incidence of urinary tract infection in the UK
• Table: US expenditure on urinary tract infection, 1994 - 2000
• Table: Expenditure on female and male urinary tract infection in the US and share of costs by site of service, 2000
• Table: Average annual spending and use of outpatient prescription drugs for treatment of UTI (male and female), 1996 - 98
• Table: Volume sales (standard units, 000s) for drugs used to treat urinary tract infections (UTIs) in the US and five major EU markets, 2007
• Table: Value sales ($000s) for drugs used to treat urinary tract infections (UTIs) in the US and five major EU markets, 2007
• Table: Aminopenicillin susceptibility results for Escherichia coli isolates in the five major EU markets, 2002 - 07
• Table: Fluoroquinolone susceptibility results for Escherichia coli isolates in the five major EU markets, 2002 - 07
• Table: Third generation cephalosporin susceptibility results for E. coli isolates in the five major EU markets, 2002 - 07
• Table: Resistance rates of outpatient Escherichia coli isolates to urinary tract infection drugs in the US and Canada, April 2003 - June 2004
• Table: Antimicrobial resistance of Escherichia coli isolates from women with community and hospital acquired urinary tract infections in Rennes, France
• Table: Antimicrobial susceptibility of Escherichia coli in 15 laboratories across nine regions in Spain, March - July 2002
• Table: Antimicrobial resistance rates of Escherichia coli isolates in 15 laboratories across nine regions in Spain, February - June 2006

FIGURES

• Figure: US expenditure on urinary tract infection (UTI), 1994 - 2000
• Figure: Volume sales (standard units, 000s) for drugs used to treat urinary tract infections (UTIs) in the US and five major EU markets, 2007
• Figure: Value sales ($000s) for drugs used to treat urinary tract infections (UTIs) in the US and five major EU markets, 2007
• Figure: Aminopenicillin susceptibility results for Escherichia coli isolates in the five major EU markets, 2002 - 07
• Figure: Fluoroquinolone susceptibility results for Escherichia coli isolates in the five major EU markets, 2002 - 07
• Figure: Third generation cephalosporin susceptibility results for E. coli isolates in the five major EU markets, 2002 - 07