Using a current example, Fidaxomicin, it's not currently the most widely used therapy for C. difficile infections, but it is used - and admittedly the price is very expensive. But there's also very little evidence of it being used in grey markets or for off label uses.
And I'm unconvinced its destined to be a commercial failure given Merck is pushing money into it.
Even if something is being used as a "drug of last resort" may have fairly high volume. For example, colistin, which is one of those drugs, are often used in combinations with other antimicrobials to help combat resistance, and is pretty much universally available to hospitals in the U.S.