🔗 Share this article

During a tenure as director general of the WHO, a past official famously stated that all of the “simple” antibiotics had already been found. The point was that in tackling the pressing danger of drug-resistant bacterial infections, we would struggle to find new treatments – or conserve the current arsenal – without finding new ways of working. This view was correct.

A Sluggish and Challenging Pipeline

Since the late 2010s, just 16 antibiotics have gained broad regulatory approval – primarily similar derivatives of drugs already in use and thus not expected to overcome resistance for long. The creation of new ones is a slow and unprofitable business, given that curative medicines are not as profitable as those managing chronic ailments. The scientific outlook continues to be grim.

A Spark 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, crucially, confirms a innovative method of encouraging development. One of the recently approved medications, a compound called Zoliflodacin, is the product of a unique type of partnership between a Swiss non‑profit and a pharmaceutical company. The non-profit provided funding and organised clinical trials to defray expenses and navigate regulatory hurdles. This sort of assistance upfront helps direct the sector towards areas of most pressing public health necessity.

This model and a separate lauded revenue guarantee scheme – initiated to guarantee revenue to firms that invest in specific antibiotics – represent the strongest chance of maintaining a dripfeed of novel treatments from the current framework.

The Inevitable Problem of Resistance

But even hurrying the development of compounds in the pipeline is not enough. The new drug is at times categorized as a novel type of antibiotic, meaning it attacks a part of the infectious bacteria that existing treatments does, in principle compelling the bacterium to start from zero in developing a countermeasure to it. Researchers and doctors are relieved to have a new drug for gonorrhea – which has resistant strains to all existing treatments – but warn that eventual drug resistance to it is inevitable.

As has grown customary with new antibiotics, exists consequently an debate about whether it should be held in reserve, restricted to highly resistant infections only – limiting its use to situations where sophisticated diagnostics is available. This sort of prudent strategy should be the worldwide norm, but often cannot be deployed readily in many regions.

A Diminishing Pipeline of Innovation

More broadly, it is difficult to see where the stream of other new antibiotics we require could possibly originate. The aforementioned statement nodded to the fact that surveying the natural world for natural sources – as with penicillin – has had declining success. Use of artificial intelligence has been proposed to speed up the search, although a highly-touted initial discovery found in recent years has not yet advanced past animal trials. Fully lab-created compounds, which are mainly or fully lab-created, are continually in development, but often run up against the fundamental rules of chemistry – just because we envision a compound doesn't mean we can create it without great difficulty.

Running Fast to Stay in Place

The dominant scientific evaluation is that when it comes to antimicrobials, we must move with great speed indeed just to remain in the current position. Prudent, globally managed deployment is the only way to preserve our advantage. Sadly, the scale of forthcoming breakthroughs is likely to seem miserly compared with the curative bonanza of the 20th century.