Antibiotics are arguably one of the great translational medicine success stories owing to their ability to reduce morbidity and mortality from infectious diseases. However, resistance to existing drugs has proliferated rapidly, while at the same time, few new antibiotics have achieved regulatory approval. One reason for the current innovation deficit is the lower perceived commercial potential of antibiotics in comparison with drugs in other classes, such as therapies for cancer and heart disease. The federal government can promote antibiotic development through greater investment in basic science research, which has supported the development of many transformative drugs. In parallel, innovations in the way antibiotics are reimbursed can alleviate economic barriers to private investment in antibiotic development. Thus far, the latter—so-called “pull” mechanisms—have been the focus of most legislative policy-making.

In our article, we examine one way in which payment policies could be adapted to promote the development of innovative antibiotics—in particular, drugs designed to treat hospitalized patients who demonstrate high rates of infection with multidrug-resistant organisms.