<p>Multidrug-resistant pathogens are a&#xa0;growing challenge in the treatment of pneumonia worldwide. The burden of disease due to associated deaths is high. Multidrug-resistant gram-negative pathogens in particular are associated with a&#xa0;high mortality rate in hospital-acquired and ventilator-associated pneumonia. Previous antibiotic treatment is considered the most important risk factor for the occurrence of resistant pathogens. The main mechanism of antibiotic resistance is the production of beta-lactamases. Resistance to carbapenems, mediated via carbapenemases, such as OXA-48, NDM and KPC, has increased the most in recent decades compared to other antibiotic classes. Even though Germany still has a&#xa0;predominantly favorable resistance profile for most species, multidrug-resistant gram-negative pathogens are also increasingly being detected in this country, not least due to the migration movements of the last 3 years. In the event of an infection, the available treatment options can be severely limited. The new preparations classified as reserve antibiotics, ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, meropenem-vaborbactam, cefiderocol, cefepime-emmetazobactam and aztreonam-avibactam, represent promising treatment options in terms of efficacy and safety and are thus replacing older treatment regimens with colistin or aminoglycosides, which have more side effects. The choice of reserve antibiotic depends on the respective resistance mechanism and should only be prescribed after prior consultation with a specialist in infectious diseases or microbiologist. Other substances are currently undergoing clinical trials or are expected to be approved in the EU soon.</p>