The Rising Demand for Macrolides & Aminoglycosides in Emerging Markets

Introduction

Infectious diseases pose a significant public health burden across emerging markets, resulting in growing reliance on antibiotic therapies. This is where antibiotics like macrolides and aminoglycosides come in.

Macrolides and Aminoglycosides are broad-spectrum antibiotics used to treat bacterial infections that range from respiratory and skin infections to severe systemic illnesses. In recent years, the demand for macrolide and aminoglycoside antibiotics has surged in low- and middle-income countries due to increased disease prevalence, improved healthcare access, and the need for cost-effective treatment options.

Macrolides, such as azithromycin and clarithromycin, are frequently prescribed for community-acquired infections and are preferred due to their oral availability and patient compliance. On the other hand, aminoglycosides, such as gentamicin and amikacin, are often administered in hospital settings to manage serious gram-negative infections and tuberculosis.

Both macrolides and aminoglycosides are considered essential medicines by the World Health Organization and are included in the WHO AWaRe antibiotics classification due to their clinical importance and growing concerns about resistance.

In this article, we will explore the rising demand for macrolides and aminoglycosides in emerging markets. We will analyze antibiotic market trends, their use patterns, supply chain dynamics, and regulatory considerations. Finally, we will discuss how pharmaceutical buyers, suppliers, and regulators can address these needs while aligning with global antibiotic stewardship initiatives.

So, without further delay, let’s get started.

Understanding Macrolides & Aminoglycosides

Antibiotics are classified based on their chemical structure, mechanism of action, and spectrum of activity. Macrolides and Aminoglycosides remain two of the most widely used and clinically significant classes of antibiotics in developed and emerging markets. Therefore, understanding their pharmacological activity is essential for effective therapeutic use and strategic sourcing.

Let’s now briefly review each class:

Macrolides

Macrolides are bacteriostatic antibiotics that inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit of bacteria. At high doses, macrolides can produce bactericidal activity as well.

Macrolide antibiotics are effective against gram-positive bacteria and atypical pathogens. The drugs are commonly prescribed to treat respiratory tract infections that include pneumonia, sinusitis, tonsillitis, and pharyngitis. They are also used to treat skin and soft tissue infections, sexually transmitted diseases (STDs), and otitis media in children.

Due to their favorable safety profile and availability in oral formulations, macrolides are widely used in pediatric and outpatient care settings, making them highly valuable in resource-limited health systems.

The most commonly used drugs from macrolide antibiotics are azithromycin, clarithromycin, and erythromycin.

Azithromycin

Azithromycin is widely used for respiratory infections and is considered a first-line agent in many treatment guidelines.

Clarithromycin

Clarithromycin is used for Helicobacter pylori eradication and bronchitis.

Erythromycin

Erythromycin is one of the earliest developed macrolides. It is used to treat chest infections, some skin conditions, and STDs. 

Aminoglycosides

Aminoglycosides are bactericidal antibiotics that bind to the 30S ribosomal subunit, leading to misreading of mRNA and bacterial death. They are highly potent against aerobic gram-negative bacteria and are often reserved for treating severe infections, such as sepsis, hospital-acquired pneumonia, and tuberculosis (TB).

The most commonly used drugs from aminoglycoside antibiotics are gentamicin, amikacin, tobramycin, neomycin, streptomycin, paramomycin, and plazomicin.

Due to their high toxicity profile (notably nephrotoxicity and ototoxicity), these antibiotics are used under close supervision and continuous monitoring. They are also mostly administered via injection because of their poor oral absorption.

Market Trends of Macrolides and Aminoglycosides in Emerging Economies

The Asia Pacific region is at the epicenter of the growing aminoglycoside antibiotics demand and macrolide API market. The growing infection rates, improved healthcare access, and well-built antibiotic manufacturing capacities – all contribute to the excessive use of these antibiotics in this region. 

Aminoglycosides Market Dynamics

The Asia Pacific aminoglycosides market was valued at USD 2.56 billion in 2024 and is projected to grow steadily, reaching USD 4.78 billion by 2034, compounding an annual growth rate (CAGR) of 6.4%.

The linear growth in the aminoglycosides market results from an increased demand in therapeutic areas such as systemic urinary tract infections (UTIs), pelvic inflammatory disease, and severe respiratory infections.

On top of that, strategic government initiatives are amplifying production of and access to these antibiotics. For instance, India’s Pharma Vision 2020 and China’s state-backed antibiotic manufacturing programs are supporting local active pharmaceutical ingredient (API) capacity and reducing reliance on imports. As a result, the macrolide API market in India and other emerging regions is strengthening and continues to expand exponentially.

Macrolides Market Dynamics

Macrolide antibiotic consumption is undergoing a marked rise across India, China, and Southeast Asia, particularly in outpatient care and pediatric populations. For instance, in Nepal, macrolide use grew from 16.7% of all antibiotic prescriptions in 2013 to 67.6% by 2021.

Similarly, China has seen a dramatic increase in overall antibiotic use, which surged by 82.6% between 2000 and 2015, totaling 4.2 billion defined daily doses.

While this market size reflects growing healthcare access and antibiotic availability in these regions, it has also triggered enhanced stewardship efforts. Several countries are also strengthening regulations to manage, monitor, and limit the use of controlled antibiotics like macrolides and aminoglycosides.

Role of WHO AWaRe Classification & Antibiotic Stewardship                     

Abbreviated for Access, Watch, and Reserve, the WHO AWaRe classification is a tool used globally as a guide for antibiotic prescribing, promoting stewardship, and combating antimicrobial resistance (AMR).

• Antibiotics in the Access group are recommended as first- or second-line treatments with a lower risk of resistance.

• Antibiotics in the ‘Watch’ category are heavily monitored because of their higher potential for developing antibiotic resistance. Macrolides and Aminoglycosides also fall under this category.

• Reserve antibiotics are narrow therapeutic index drugs. They are considered last-resort options and are reserved for severe, multidrug-resistant infections.

Despite WHO’s guidance, many low- and middle-income countries face challenges in implementing effective antibiotic stewardship programs. In these regions, excessive over-the-counter antibiotic sales, suboptimal diagnostic infrastructure, and limited clinician training result in misuse and overuse of Watch-category antibiotics, resulting in serious implications for hospital formularies and national procurement policies.

Both WHO and the Global Antibiotic Research and Development Partnership (GARDP) have raised alarms over rising antibiotic shortages, warning that supply chain disruptions and growing AMR could precipitate a public health and economic crisis. In fact, according to WHO projections, antimicrobial resistance could cost the global economy up to USD 412 billion annually by 2030 if left unaddressed.

The only way to manage this is to strengthen stewardship policies and align procurement decisions with the AWaRe framework to protect the efficacy of vital antibiotics like macrolides and aminoglycosides in emerging markets.

Supply Chain and Sourcing Considerations of Macrolides and Aminoglycosides

The global supply chain for macrolide and aminoglycoside antibiotics is under increasing strain due to rising demand. These antibiotics are essential in community and hospital settings, and any disruption in their availability can have direct consequences on patient care and national treatment protocols.

The Active Pharmaceutical Ingredients (APIs) for these classes are primarily manufactured in China and India, which together account for over 60% of the global antibiotic API supply. However, consistent regulatory oversight, such as GMP inspections, Certificate of Suitability (CEP) approvals, Drug Master Files (DMF), and WHO Prequalification (WHO PQ) listings, is essential to ensure quality, safety, and continuity of supply of these APIs for export into regulated markets.

The COVID-19 pandemic revealed vulnerabilities in the global API supply chain, including bottlenecks, logistics delays, and export controls on critical antibiotics. In response, countries like Brazil, Vietnam, and Pakistan have introduced incentives to encourage local production of essential antibiotics. However, technology transfer and a lack of proper regulatory oversight remain significant hurdles in local production.

This is where digital platforms like PharmaSources.com play a critical role in connecting global buyers with GMP-compliant, quality-assured API and finished dose suppliers. These platforms facilitate transparency in sourcing, improve supplier vetting, and offer valuable insights into pricing, availability, and regulatory documentation, all of which can enable you to build a supporting supply chain network amidst growing antibiotic demand in the emerging markets.

Conclusion

Macrolides and aminoglycosides continue to remain preferred antibiotics for various infectious diseases in low- and middle-income countries where alternative therapies may be limited. Despite their long-standing use, the future of antibiotics in Asia heavily depends on innovation and responsible management. While the current antibiotic development pipeline remains limited, emerging technologies offer promise in accelerating resistance prediction through artificial intelligence, enhancing drug design, and enabling effective delivery mechanisms that can optimize therapeutic outcomes and extend the clinical use of existing antibiotic classes.

When it comes to artificial intelligence, AI-enabled drug discovery is being used to predict resistance patterns and design next-generation aminoglycosides with enhanced efficacy and reduced toxicity. Simultaneously, advances in drug delivery in the form of liposomal formulations and extended-release oral macrolides are also improving pharmacokinetics and patient adherence.

Coming to the ongoing supply vulnerabilities in the wake of global health crises, investment in regional manufacturing capacity is vital. Local production can mitigate dependence on overseas suppliers and reduce the impact of export controls and shipping delays. However, as discussed earlier, increasing access to antibiotics must be regulated with robust antimicrobial stewardship to curb the spread of resistance.

Finally, pharma buyers, regulators, and procurement leaders must adopt data-driven sourcing strategies.

We, at PharmaSources.com, facilitate supplier vetting, documentation review, and regulatory compliance.

About the Author

Saher Haider

PharmD, Medical & Life Sciences Content Creator.

Saher Binte Haider is a pharmacy graduate from Dow University of Health Sciences. She started her career as a Quality Management professional in the pharmaceutical industry where she developed a keen interest in good documentation practices, SOP creation, and content writing. She has 7+ years of experience in healthcare & life sciences content writing. Her key areas of expertise are healthcare, pharmaceuticals, health tech, and AI in healthcare.