🔗 Share this article

During a time as head of the WHO, a former leader famously stated that all of the “simple” antimicrobials had already been found. The point was that in addressing the pressing danger of antibiotic-resistant infections, we would face difficulties to find new medicines – or conserve the current arsenal – without developing novel approaches of working. This view was accurate.

A Sluggish and Challenging Development Path

Since 2017, only 16 antimicrobial agents have received widespread regulatory approval – mostly similar derivatives of medicines currently available and thus not expected to evade resistance for an extended period. The creation of novel compounds is a slow and financially unattractive endeavor, given that curative medicines are not as profitable as ones treating longer-term conditions. The overall prospect remains bleak.

A Glimmer of Optimism and a Novel Approach

However, the recent announcement of a pair of novel regulator-approved antibiotics against gonorrhea is a welcome development and, crucially, validates a innovative method of incentivising development. A particular of the recently approved medications, Zoliflodacin, is the product of a novel kind of partnership between a Swiss non‑profit and a pharmaceutical company. The non-profit provided financial support and organised testing phases to defray expenses and clear regulatory hurdles. This type of support in advance helps steer the industry towards areas of most pressing global need.

This approach and another praised “subscription model” – launched to guarantee income to companies investing in certain antimicrobials – represent the strongest chance of sustaining a trickle of novel treatments from the existing system.

The Unavoidable Challenge of Resistance

But even hurrying the development of drugs in the pipeline isn't sufficient. The new drug is sometimes described as a new class of antimicrobial, meaning it attacks a component of the infectious bacteria that no other drug does, theoretically compelling the bacterium to start from zero in developing a countermeasure to it. Scientists and physicians are grateful to have a new option for gonorrhoea – which has strains resistant to all existing treatments – but warn that eventual drug resistance to it is inevitable.

As has become the norm with new antibiotics, exists therefore an debate about whether it should be stockpiled, rationed to highly resistant infections only – confining its use to situations where high‑end lab testing is available. This kind of prudent approach should be the worldwide norm, but frequently cannot be deployed easily in many parts of the world.

A Dwindling Pipeline of Innovation

More broadly, it is hard to see where the flow of other new antibiotics we require could possibly come from. The former official's statement nodded to the fact that searching the living world for biological compounds – as with penicillin – has had declining success. Use of AI has been proposed to speed up the search, although a highly-touted initial discovery found in recent years has not yet advanced past preclinical studies. Synthetic drugs, that are mainly or fully synthesized, are continually in development, but often run up against the fundamental rules of chemistry – the fact that we envision a molecule does not guarantee we can synthesise it without great difficulty.

Running Fast to Stand Still

The prevailing expert assessment is that when it comes to antibiotics, we must run very fast indeed just to stay in the same place. Careful, internationally coordinated use is the only way to maintain our advantage. Sadly, the magnitude of forthcoming breakthroughs is going to seem meager in contrast to the therapeutic revolution of the 20th century.