经济学人下载:抗生素生产商的困境(2)

The demise of Achaogen has been blamed on the peculiar features of the antibiotics market,
Achaogen的破产被归咎于抗生素市场的独特特征，

rather than the poor business decisions of its managers.
而不是其管理者糟糕的商业决策。

The low number of cases that are suitable for potential treatment with novel antibiotics makes it hard to recruit enough patients for clinical trials.
适合使用新型抗生素进行潜在治疗的病例数量较低，这使得招募足够数量的病人进行临床试验变的困难。

Take carbapenem-resistant Enterobacteriaceae (or CRE for short), which Achaogen went after.
以耐碳青霉烯类肠杆菌（简称CRE）为例，Achaogen就是做这个。

These bacteria kill half of those whose bloodstream they infect. But CREs cause only a tiny fraction of bacterial infections in American hospitals.
这些细菌会杀死一半的血液被感染者。但在美国医院中，CRE仅引起了很小一部分的细菌感染。

Firms get around this by having their new antibiotics approved for more common ailments treatable with existing drugs, such as urinary-tract infections.
公司通过让他们的新抗生素得到批准并用于现有药物可治疗的更常见疾病来规避这一问题，比如尿路感染。

At the same time, they publish results from small observational trials of the new drugs showing good recovery rates for hospital patients with CRE infections
与此同时，他们公布了这些新药的小型观察性试验结果，结果表明感染了CRE的住院患者有良好的康复率

—counting on doctors to prescribe the medicines off-label for CRE.
—指望医生能够为CRE开出未被临床试验认可的药物。

In the case of Achaogen, a small study showed that plazomicin was indeed safer and more effective for CRE than colistin,
以Achaogen为例，一项小型研究表明plazomicin确实比粘菌素更加安全有效，

a highly toxic antibiotic of last resort from the 1950s. Yet plazomicin did not make a dent in colistin use.
粘菌素是一种源于20世纪50年代的最后一种剧毒抗生素。但plazomicin的问世并没有减少粘菌素的使用。

A CRE antibiotic by Melinta that has been on the market for over a year is not selling well, either.
Melinta的CRE抗生素已上市一年多，但销量也不好。

That could be because few doctors know about the new treatments.
这可能是因为知道这种新治疗方法的医生并不多。

The firms which sell them lack the marketing dollars that big pharma firms shower on new drugs,
销售它们的公司缺乏大型制药公司投入新药的市场资金，

says Alan Carr, an analyst at Needham, an asset manager in New York.
Needham分析师兼纽约资产经理阿兰·卡尔表示。

It takes time for new antibiotics to make it into clinical guidelines,
新抗生素列入临床指南需要时间，

such as those of the Infectious Diseases Society of America, which are updated infrequently.
比如美国感染病学会的那些，其更新并不频繁。

American hospitals, meanwhile, avoid new antibiotics because they end up footing the bill, which can run to several thousand dollars per patient.
同时，美国医院会避免使用新抗生素，因为最终他们需要自己买单，每名病人要花几千美元。