Antibiotics: Recent Advances Provide Positive News, Yet We Are Losing the Bigger Race

During a tenure as director general of the WHO, a former leader famously stated that all of the “simple” antimicrobials had already been found. The argument was that in tackling the urgent danger of drug-resistant infections, we would face difficulties to find new medicines – or conserve the existing ones – without finding new ways of operating. This assessment proved accurate.

A Slow and Unprofitable Development Path

Since 2017, only sixteen antibiotics have gained widespread official clearance – primarily similar derivatives of drugs already in use and thus unlikely to overcome resistance for long. The development of new ones is a slow and financially unattractive endeavor, given that curative treatments are less lucrative as ones managing chronic ailments. The overall prospect remains grim.

A Glimmer of Optimism and a New Model

However, the recent announcement of a pair of novel FDA-approved antibiotics for gonorrhoea is a welcome development and, importantly, confirms a innovative method of incentivising research. A particular of the new drugs, Zoliflodacin, is the result of a novel kind of collaboration between a Swiss non‑profit and a pharmaceutical company. The public health partnership supplied financial support and organised testing phases to defray expenses and clear regulatory hurdles. This type of support upfront helps direct the sector towards areas of greatest global need.

This approach and a separate lauded “subscription model” – initiated to ensure income to companies investing in specific antimicrobials – represent the strongest chance of sustaining a dripfeed of new drugs from the current system.

The Inevitable Challenge of Drug Resistance

But even hurrying the development of compounds in the pipeline isn't sufficient. The new drug is at times described as a new class of antibiotic, indicating it targets a component of the pathogen that no other drug does, theoretically forcing the bacterium to start from zero in evolving a defense to it. Researchers and physicians are relieved to have a new option for gonorrhoea – which has resistant strains to all existing treatments – but caution that eventual drug resistance to it is inevitable.

As has grown customary with recent antimicrobials, exists consequently an argument about whether it should be stockpiled, restricted to extremely drug-resistant infections only – limiting its use to settings where high‑end lab testing is accessible. This kind of rational approach should be the global standard, but often can't be deployed readily in many regions.

A Dwindling Stream of Innovation

More broadly, it is difficult to see where the stream of other novel antimicrobials we need could possibly come from. The aforementioned comment nodded to the fact that searching the living world for biological compounds – as with penicillin – has had declining success. The application of AI has been proposed to speed up the discovery process, although a much-celebrated initial discovery identified in recent years hasn't yet progressed past preclinical studies. Synthetic drugs, which are largely or entirely lab-created, are continually in research, but often run up against the iron laws of chemistry – just because we imagine a molecule doesn't mean we can create it without great difficulty.

Moving Quickly to Stay in Place

The dominant scientific evaluation is that when it comes to antimicrobials, we must move with great speed truly just to remain in the current position. Prudent, globally managed use is the sole method to preserve our therapeutic edge. Sadly, the scale of forthcoming breakthroughs is likely to seem miserly in contrast to the curative bonanza of the previous century.