Merck is pulling Recarbrio — a combination antibiotic (imipenem-cilastatin + relebactam) approved to treat multidrug-resistant UTIs, intra-abdominal infections, and hospital-acquired pneumonia — from the U.S. market. The company cited an "ongoing portfolio review," not safety or quality concerns. Remaining inventory was expected to run out by the end of September 2026.

The clinical fallout is real but targeted. Infectious disease experts say the biggest losers are patients with difficult-to-treat Pseudomonas aeruginosa, for whom imipenem-relebactam was one of only a handful of preferred options. For KPC-producing carbapenem-resistant infections, alternatives like ceftazidime-avibactam and cefiderocol remain available — though the list keeps getting shorter.

The bigger story is the broken economics of antibiotic development. Because stewardship programs rightly limit antibiotic use, last-resort drugs sit on shelves and generate little revenue — making them financially unsustainable even for pharma giants like Merck. Experts are pointing to the PASTEUR Act, a bipartisan but still-unpassed bill that would pay companies fixed annual fees for novel antibiotics regardless of usage volume, as the structural fix needed to prevent more exits like this.

Key Takeaways

• Recarbrio's loss is most acutely felt for Pseudomonas aeruginosa infections; alternatives exist for KPC-producing CRE
• Merck had expanded Recarbrio's label to pediatric patients (down to 2 kg) in 2025 — raising concerns about who will fund similar pediatric studies for future antibiotics
• The PASTEUR Act, reintroduced in February 2026, proposes a "Netflix-style" subscription model to decouple antibiotic revenue from volume of use

Why it matters: When both startups and pharmaceutical giants can't sustain last-resort antibiotics on the market, the pipeline for fighting drug-resistant infections shrinks — and resistance doesn't wait. Without structural payment reform, clinicians will keep losing tools they can't afford to lose.