Infectious Disease Treatment Market

Carbapenem antibiotics have reached hospital patients through a drip for decades, so the 600 mg tebipenem pivoxil tablet taken every six hours, cleared by the US Food and Drug Administration (FDA) as Utebzi on 17 June 2026 according to GSK’s approval release, moves a last-line drug class into the pharmacy bag. The Infectious Disease Treatment market covers prescription medicines that cure or suppress infections: antibacterials, antiretrovirals, hepatitis and other antivirals, antifungals, antimycobacterials and antiparasitics, sold to hospitals, pharmacies and donor tenders. Douglas Insights sizes it at USD 118.57 billion for 2025, built as 3.28 billion treatment courses at an average USD 36.15 per course, and projects USD 164.40 billion by 2035, a 3.32% revenue CAGR from 2026 to 2035. The study belongs to our pharmaceuticals coverage and uses the bottom-up build described in our research methodology.

Why is demand for infectious disease treatment climbing as carbapenem resistance spreads?

Volume adds 2.4 points a year to infectious disease treatment revenue. Four forces supply it: wider antiretroviral coverage, resistant bacterial infections needing second-line courses, a hepatitis C cure backlog and more immunocompromised patients, while price adds 0.9 points.

Resistance is the first driver, worth 0.8 points of volume growth. The World Health Organization (WHO) reported on 13 October 2025 that about 1 in 6 laboratory-confirmed bacterial infections in 2023 resisted antibiotic treatment, and that resistance rose in over 40% of monitored pathogen and antibiotic pairs between 2018 and 2023, by 5% to 15% a year (WHO surveillance release). Over 40% of E. coli and over 55% of K. pneumoniae now resist third-generation cephalosporins. Each failed first course triggers a second, longer and costlier one, so a rising resistance rate lifts course counts faster than patient counts.

Antiretroviral therapy (ART) is the second driver, worth 0.7 points. The 2026 fact sheet from the Joint United Nations Programme on HIV/AIDS (UNAIDS) counts 32.1 million people on treatment in 2025 out of 41.0 million living with human immunodeficiency virus (HIV), up from 31.1 million in 2024 and 16.8 million in 2015 (UNAIDS global factsheet). That is 78.3% coverage, and every extra patient adds 12 monthly courses a year for life.

Hepatitis C is the third driver, worth 0.3 points. WHO puts chronic infections at about 47 million and says about 11 million diagnosed people were still untreated at the end of 2024, although direct-acting antiviral (DAA) courses cure more than 95% of patients in 12 to 24 weeks (WHO hepatitis C fact sheet). The backlog converts into one-off courses rather than lifelong demand.

Ageing and immunosuppression form the fourth driver, worth 0.6 points. Transplant, oncology and intensive care patients need antifungal and cytomegalovirus (CMV) prophylaxis; Pfizer’s Cresemba grew 24% to USD 349 million in 2025, per its full-year earnings release. The four contributions, 0.8, 0.7, 0.3 and 0.6 points, add up to the 2.4-point volume leg.

Oral replacements for drip therapy sit on top. Utebzi, approved on 17 June 2026, and gepotidacin (Blujepa), the first new oral antibiotic class for uncomplicated urinary infections in nearly 30 years when GSK announced its approval on 25 March 2025 (GSK Blujepa release), move patients home sooner. Douglas Insights counts that shift inside the price leg, since branded oral courses replace cheaper generic injections.

What headwinds pull antiviral revenue and generic antibiotic prices down in infectious disease treatment?

Three headwinds remove 1.3 points from infectious disease treatment growth: the collapse in coronavirus disease 2019 (COVID-19) antivirals, generic price erosion in antibacterials and a shrinking donor budget for HIV medicines. Without them, Douglas Insights reckons the revenue CAGR would sit near 4.6% instead of 3.32%.

Post-pandemic antiviral decline removes 0.4 points. Pfizer’s Paxlovid fell 59% to USD 2.36 billion in 2025 from USD 5.72 billion in 2024, citing lower infection rates (Pfizer results), and Gilead’s Veklury dropped 49% to USD 911 million (Gilead results). That revenue does not return in the base case.

Generic erosion removes 0.6 points from the price leg. Most of the 2.38 billion antibacterial courses in our ledger are off-patent, and Pfizer’s own Zithromax slipped 17% to USD 399 million in 2025 in the same release. Without that erosion, the price leg would run at 1.5% a year rather than 0.9%.

Donor funding removes 0.3 points of volume. UNAIDS says USD 17.6 billion was available for HIV in low- and middle-income countries in 2025, down from USD 18.8 billion in 2024 and about 20% short of the USD 21.9 billion needed each year by 2030 (UNAIDS factsheet). Slower enrolment in donor-funded clinics trims the antiretroviral volume that the coverage driver would otherwise add.

Which drug class leads infectious disease treatment revenue: antibacterials or HIV antiretrovirals?

Antibacterials lead infectious disease treatment with 38.6% of 2025 revenue, USD 45.77 billion, because they treat the most patients, while HIV antiretrovirals hold 27.9% with only one in nine courses, thanks to branded single-tablet regimens. Antifungals grow fastest, at 4.3% a year.

Antibacterials take USD 45.77 billion because 2.38 billion courses, mostly cheap generics, treat urinary, respiratory and wound infections everywhere. Their 3.6% growth comes from resistance, which pushes doctors toward costlier reserve agents such as Zavicefta and Utebzi.

HIV antiretrovirals earn USD 33.08 billion from 385.2 million monthly courses, or 32.1 million patients times 12 months. High-income markets pay for patented regimens, so value per course is more than four times the antibacterial average. Growth of 3.9% a year tracks new enrolment and long-acting injectables.

Hepatitis and other antivirals, worth USD 17.43 billion, cover hepatitis B and C, influenza, herpes, CMV and COVID-19 drugs. At 1.2% a year they grow slowest, because cured hepatitis C patients leave the pool and pandemic stockpiles have run down.

Antifungals, the fastest-growing class at 4.3% a year, earn USD 11.62 billion today. Growth comes from more transplant, chemotherapy and intensive care patients, who need azoles and echinocandins for weeks.

Antimycobacterials bring in USD 5.22 billion from tuberculosis and non-tuberculous mycobacterial regimens, growing 3.1% a year as drug-resistant strains need longer regimens.

Antiparasitics and antimalarials add USD 5.45 billion. Their 266.8 million courses are among the cheapest in the ledger at about USD 20 each, and growth of 2.6% a year is the second slowest of the six classes. By 2035 the six classes sum to USD 165.16 billion, within 0.5% of the top-down total.

Where do antibiotic and antiretroviral prescriptions earn the most, region by region?

North America earns the most from infectious disease treatment, USD 49.33 billion or 41.6% of 2025 revenue, because branded HIV regimens and hospital reserve antibiotics sell at list prices far above those in tender markets. Asia Pacific grows fastest, at 4.52% a year.

North America grows 2.86% a year to USD 65.39 billion by 2035, held back by generic entry but supported by new oral antibiotics such as Utebzi, with US availability expected by the end of 2026.

Europe holds USD 27.86 billion and grows at 2.47%, the slowest rate, because national tenders squeeze antibacterial prices and HIV treatment coverage is already high.

Asia Pacific, at USD 28.81 billion, is the fastest-growing region at 4.52% a year. Resistance rates are highest in South-East Asia, where WHO counts about 1 in 3 infections as resistant, which pushes doctors toward second-line courses.

Latin America adds USD 7.23 billion and grows at 3.94%, helped by public antiretroviral programmes and hospital antifungal use.

The Middle East and Africa is the wildcard. Its USD 5.34 billion in 2025 grows at 4.08% a year to USD 7.96 billion, but it depends on donor money, and UNAIDS data show HIV resources in low- and middle-income countries fell 6.4% between 2024 and 2025.

Which companies supply the antiretroviral and reserve antibiotic portfolios that set infectious disease treatment share?

Gilead Sciences leads infectious disease treatment with an estimated 18.3% share of 2025 revenue, based on USD 20.8 billion of HIV sales plus USD 911 million of Veklury. GSK, Pfizer, Merck, AbbVie and Spero Therapeutics follow with narrower franchises.

Gilead’s position rests on Biktarvy, which grew 7% to USD 14.3 billion in 2025, and on Descovy, up 31% to USD 2.8 billion, according to its full-year 2025 results. HIV sales rose 6% to USD 20.8 billion overall. Douglas Insights calculates the 18.3% share by dividing Gilead’s HIV and Veklury sales of USD 21.71 billion by the market size, treating its pre-exposure prophylaxis (PrEP) sales as part of the HIV line.

GSK, through its ViiV Healthcare HIV business, grew HIV sales 11% at constant exchange rates in 2025, with Cabenuva up 42% and over 75% of growth coming from long-acting injectables. It also owns Blujepa and Utebzi, the two newest oral antibiotics in the US, as described in the Utebzi release.

Pfizer holds the broadest hospital anti-infective portfolio: Zavicefta at USD 638 million, Sulperazon at USD 653 million, Zithromax at USD 399 million, Cresemba at USD 349 million and Paxlovid at USD 2.36 billion in 2025, as listed in the Pfizer earnings release. Merck reported Prevymis at USD 978 million, Lagevrio at USD 380 million, Isentress at USD 325 million and Zerbaxa at USD 312 million, while AbbVie’s Mavyret for hepatitis C held flat at USD 1.32 billion.

Spero Therapeutics developed tebipenem pivoxil and licensed it to GSK in September 2022, keeping rights in certain Asian territories. Indian generic manufacturers, whose licensing deals set the 2017 price ceiling for first-line HIV tablets, supply the tender channel.

How much does a course of HIV, hepatitis C or reserve antibiotic therapy cost buyers?

Infectious disease treatment prices run from under USD 3.75 a month for generic first-line HIV therapy to about USD 147.71 per antiviral course. English reserve antibiotics earn fixed fees of up to GBP 20 million a year. Douglas Insights puts the blended 2025 average at USD 36.15 per course.

At the low end, the Global Fund announced on 30 August 2023 that first-line tenofovir, lamivudine and dolutegravir (TLD) would cost under USD 45 per person per year, 25% below the earlier ceiling of about USD 75 (Global Fund release). That works out at under USD 3.75 a month. WHO says a curative generic hepatitis C course costs less than USD 50 in many low- and middle-income countries.

Branded regimens set the high end. Douglas Insights estimates a blended USD 85.88 per HIV monthly course worldwide, a figure that mixes generic tablets in Africa with patented single-tablet regimens in the US. Antibacterials average about USD 19.23 per course, antifungals USD 126.31 and other antivirals USD 147.71.

Reserve antibiotics are moving to fixed fees. The National Health Service (NHS) England subscription model pays up to GBP 20 million a year for a band 1 breakthrough antimicrobial, GBP 15 million for band 2, GBP 10 million for band 3 and GBP 5 million for band 4, for an initial 3 years extendable to 15 (NHS England guidance). Payment is separated from volume, so stewardship does not cut the supplier’s revenue.

How do subscription contracts and FDA approval rules reshape antibiotic policy for infectious disease treatment?

Two policy tools shape infectious disease treatment in 2026: national approvals that let new oral agents replace drips, and pull incentives that pay for reserve antibiotics regardless of volume. England’s model pays up to GBP 20 million per product per year; the US still pays per course.

NICE and NHS England awarded the first subscription-style contracts, for ceftazidime with avibactam and for cefiderocol, in July 2022, then opened a wider commissioning route in May 2024 and a first procurement round in August 2024 (NHS England). Products must target WHO priority pathogens such as carbapenem-resistant Acinetobacter baumannii and score at least 50% on the evaluation to win a contract.

FDA approvals set the pace in the largest market. Utebzi was approved on 17 June 2026 after the PIVOT-PO trial, which enrolled 1,690 patients and showed 58.5% overall success against 60.2% for intravenous imipenem-cilastatin (GSK). The label limits it to adults with few oral alternatives, a stewardship rule that caps early volume.

What does the oral carbapenem approval change for infectious disease treatment in hospitals?

The oral carbapenem approval moves part of the 3 million US complicated urinary tract infection (cUTI) cases treated each year toward home therapy. GSK says treatment fails in up to 34% of those patients, and up to a third face resistant bacteria.

A tablet taken four times a day for 7 to 10 days replaces an infusion every six hours, so the cost moves from hospital beds to the drug. Douglas Insights expects branded oral reserve antibiotics to supply about 0.3 points of the 0.9-point price leg once US availability begins at the end of 2026, as the approval release states.

Stewardship limits the upside. The label restricts use to patients with limited oral options, and GLASS, the Global Antimicrobial Resistance and Use Surveillance System, shows 48% of countries did not report data in 2023, so many markets cannot yet target reserve drugs well.

Which buyers pay for infectious disease treatment: hospital pharmacies, retail pharmacies or donor and public tenders?

Hospital pharmacies buy about 46.2% of infectious disease treatment value, Douglas Insights estimates, because reserve antibiotics, antifungals and CMV drugs are given to inpatients. Retail pharmacies take 41.7%, and donor and public tenders take the remaining 12.1%.

The split follows the setting of care. Hospital-treated infections include sepsis, pneumonia on ventilation and invasive candidiasis, which need weeks of therapy. Community infections, such as urinary infections, sexually transmitted infections and chronic HIV, run through retail pharmacies and specialty dispensers.

Donor and public tenders buy the cheapest courses but the most patients. Global Fund pooled procurement serves grant implementers in 90 countries, so a 1% tender price cut reaches millions of patients but removes little revenue.

What if resistance accelerates or HIV funding falls: how far apart are the 2035 infectious disease treatment outcomes?

The 2035 infectious disease treatment outcome ranges from USD 143.23 billion to USD 186.67 billion, with USD 164.40 billion in the base case. Resistance speed and donor money decide where it lands; each extra point of volume growth adds USD 16.78 billion.

The base case assumes 2.4% volume growth and 0.9% price growth, giving a 3.32% revenue CAGR. Units rise from 3.28 billion courses in 2025 to about 4.16 billion in 2035, and the average price rises from USD 36.15 to USD 39.54 per course.

The slower case cuts volume growth to 1.4% and price growth to 0.5%, a 1.91% CAGR ending at USD 143.23 billion. It assumes donor HIV budgets keep falling from USD 17.6 billion and that pull incentives stay confined to England.

The faster case lifts volume growth to 3.3% and price growth to 1.3%, a 4.64% CAGR ending at USD 186.67 billion. It assumes resistance keeps rising 5% to 15% a year and oral reserve drugs such as Utebzi, approved on 17 June 2026 (GSK), gain wider labels.

Published forecasts for comparable scopes range from 1.61% to 6.9% a year. Our 3.32% sits in the lower half of that range because we net out the COVID-19 antiviral decline and treat HIV generics at tender prices.

Douglas Exclusive: the Infectious Disease Treatment Course Ledger

The Course Ledger is a Douglas Insights model, not an official register. It is built from 19 sourced inputs: 12 company revenue lines from Gilead, Pfizer, Merck and AbbVie, 4 WHO and UNAIDS patient counts, 2 price anchors from the Global Fund and WHO, and the NHS England fee bands.

It assigns all 3.28 billion treatment courses to six drug classes and divides each class’s value by its courses. A month of chronic therapy counts as one course.

The finding is lopsided. Antibacterials fill 72.6% of courses but earn 38.6% of value, while HIV antiretrovirals fill 11.7% of courses and earn 27.9%. Infectious disease treatment revenue therefore depends more on patent cliffs in HIV than on infection counts, and a 10% price cut on HIV regimens moves the total by USD 3.31 billion.

Methodology check: how do 3.28 billion infectious disease treatment courses multiply out to the 2025 figure?

The infectious disease treatment model multiplies 3.28 billion courses by USD 36.15 per course to reach USD 118.57 billion, then applies 2.4% volume and 0.9% price growth for ten years. Six drug classes and five regions reconcile to that total.

Inputs: 32.1 million people on HIV treatment times 12 months gives 385.2 million courses; antibacterial, antifungal, antiviral, antimycobacterial and antiparasitic courses are set so that each class’s value matches company revenue anchors scaled for generics.

Cross-check one: Gilead’s USD 20.8 billion HIV line equals 62.9% of our USD 33.08 billion antiretroviral segment, consistent with Gilead’s leading US position plus GSK and generic supply elsewhere. Cross-check two: published 2025 estimates for similar scopes run from USD 72.5 billion to USD 139.6 billion, and our USD 118.57 billion sits inside that range.

Cross-check three: the six segment values for 2035 add to USD 165.16 billion, 0.46% above the top-down USD 164.40 billion. The five regional values add exactly to the global total in both years.

Sources

1. GSK Utebzi (tebipenem pivoxil) approved in the US for adults with cUTIs (2026)
2. GSK Blujepa US FDA approval (2025)
3. Gilead Sciences Fourth quarter and full year 2025 financial results (2026)
4. UNAIDS Global HIV factsheet 2026 (2026)
5. World Health Organization WHO warns of widespread resistance to common antibiotics worldwide (2025)
6. World Health Organization Hepatitis C fact sheet (2025)
7. NHS England Antimicrobial products subscription model (2024)
8. Pfizer Q4 2025 earnings release (2026)
9. Merck Fourth-quarter and full-year 2025 financial results (2026)
10. AbbVie Full-year and fourth-quarter 2025 financial results (2026)
11. The Global Fund First-line HIV treatment below USD 45 a year (2023)

Which infections and therapies fall inside the infectious disease treatment scope, and which are left out?

The infectious disease treatment scope includes 6 drug classes, 2 care settings and 3 channels; vaccines, diagnostics and PrEP as a standalone category are excluded. The scope covers hospital-treated infections and community infections alike.

Coverage by drug class: antibacterials, HIV antiretrovirals, hepatitis and other antivirals, antifungals, antimycobacterials, and antiparasitics and antimalarials. Coverage by channel: hospital pharmacies, retail pharmacies, and donor and public tenders. Testing sits in our Antimicrobial Susceptibility Test Market and Blood Culture Bottle Market reports, while branded medicines as a whole sit in the Pharmaceutical Drug Market.

Volume is counted in courses. One course is a full acute regimen, such as 5 days of an oral antibiotic, or one month of chronic therapy. Values are manufacturer net sales in US dollars at 2025 prices.