Around 5 years ago there were some 104k sepsis admissions in...

Around 5 years ago there were some 104k sepsis admissions in Australian hospitals. 11% of those died. The cost per episode was estimated at the time at $AUD39k per episode. A lot of this cost is not pharmacological cost and I agree is the true reason few antibiotics are developed. The other reason is eventually the antibiotic becomes less effective due to resistance with overuse and actually may not be effective at all in some bacteria. The difference with RCE is it does not lead to resistance in the trials and seems to be sensitive in gram-negative and gram-positive bacteria and possibly some viruses. This means it can be given empirically and prophylactically (long term) to a range of patients who are at risk of bacterial infections. This creates demand since no other antibiotic can be given prophylactically since it promotes resistance and current antibiotics are useful only sometimes depending on the invading colony. It is purely for this reason we have a reactive treatment regime over a prophylactic one. Some localised bacterial infections will lead to sepsis which leads to a very expensive hospital admission and a probability of death of 10 - 40% depending on your country. We know who the at-risk populations are: the recurrent UTI patient with a history of Urosepsis; the international traveler; the post-coital female UTI; the obstructed male UTI; the immunocompromised; the diabetic; the older adult; those with medical devices such as urinary catheters or central venous lines; those with renal stones. There is also a range of patients who do not develop blood sepsis but have an uncomfortable life with localised bacteriuria associated with urinary catheters or an infected wound that does not heal or the localised effects of bacteria in a medical device such as a hip replacement or IV cannula. Travelers' diarrhea also comes to mind.

So yes, RCE is a winner because unlike other treatments it can be given both empirically and prophylactically. There is plenty of demand for such a drug both in an acute and community setting so your demand argument is false. The demand I see every day in my work is larger than you can imagine. Also, I believe the manufacturing process to be cheap and thus can be competitively priced while providing investors with the rewards we all deserve.

Oral long term prophylactic use of antibiotics, however, is a risk investors should be aware of. Oral RCE435 may need closer scrutiny since we now know that altered normal flora of the gut is associated with some brain (eg parkinsons) and gut disorders (irritable bowel). What is not known though is does the disorder lead to the altered gut flora or the other way around - chicken or the egg. A lot of research into the gut-brain axis is being performed. Some oral antibiotics are poorly absorbed and are excreted largely via bowel which interferes with the normal flora eg Flagyl. Widespread Prophylactic use of oral RCE435 would need to prove it is absorbed completely in the upper alimentary tract and that it does not alter the normal flora of the distal gut to be a prophylactic market success. Studies have shown that parenteral (not by the mouth or alimentary canal) administration of antibiotics does not cause appreciably altered gut flora provided the unmetabolised drug is not secreted into the bowel. I think Vancomycin is not metabolised and leaves mostly by renal system but some leaches into the bowel via bile. It's probably the reason why we have so much VRE (Vancomycin resistant E.coli.) in hospitals. So in theory parenteral RCE 327 would be okay long term repeated doses provided it is metabolised or only leaves via the renal system. Long term parental administration by injection isn't that practical in the community but dosages administered via a polymer coating onto/into devices such as joint replacements, prostheses, catheters, cannulas etc thus keeping those devices sterile while in the body. A spray for topical administration is also under research / trials and similarly could be used long term. The above is purely speculation in how I see this working.

RCE is an interesting story that offers quite a lot of hope to humans and may prevent many premature deaths associated with sepsis. I feel it is worthy of investment albeit "speculative grade". With a market cap of $100m and two routes of administration in phase 2 trials, it is currently an attractive opportunity.