Antibiotics: New Advances Are Great Developments, But We Are Losing the Larger Battle

During a tenure as director general of the World Health Organization, a past official famously remarked that all of the “simple” antimicrobials had already been found. The argument was that in tackling the urgent threat of antibiotic-resistant bacterial infections, we would struggle to find new treatments – or conserve the current arsenal – without developing new ways of working. This view proved correct.

A Slow and Unprofitable Pipeline

Since 2017, only 16 antibiotics have received broad official clearance – primarily close relatives of medicines currently available and thus unlikely to evade bacterial resistance for long. The creation of new ones is a lengthy and unprofitable endeavor, given that one-off treatments are not as profitable as ones managing chronic conditions. The overall prospect continues to be bleak.

A Spark of Optimism and a Novel Approach

However, the recent announcement of a pair of novel regulator-approved antibiotics against gonorrhoea is a welcome development and, crucially, confirms 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 global health organization and a pharmaceutical company. The non-profit supplied funding and organised testing phases to offset expenses and navigate approval processes. This sort of assistance in advance helps steer the industry towards fields of most pressing global need.

This model and a separate lauded “subscription model” – initiated to guarantee revenue to firms that invest in specific antimicrobials – represent the strongest chance of sustaining a trickle of novel treatments from the existing system.

The Inevitable Problem of Drug Resistance

But even hurrying the development of drugs in the pipeline is not sufficient. The new drug is at times categorized as a novel type of antimicrobial, indicating it attacks a component of the infectious bacteria that no other drug does, in principle forcing the bacterium to start from zero in developing a countermeasure to it. Researchers and physicians are relieved to have a new drug for gonorrhea – which has strains resistant to every known antibiotic – but caution that future resistance to it is certain.

As has become the norm with new antibiotics, exists therefore an debate about whether it should be held in reserve, rationed to highly resistant infections only – limiting its application to situations where sophisticated diagnostics is accessible. This kind of prudent strategy should be the global standard, but often cannot be deployed easily in many parts of the world.

A Dwindling Pipeline of Discovery

On a wider scale, it is difficult to see where the stream of additional new antibiotics we require could possibly come from. The former official's comment nodded to the fact that searching the living world for natural sources – as with the first antibiotic – has had declining success. The application of AI has been proposed to accelerate the discovery process, although a much-celebrated early candidate identified in 2020 hasn't yet progressed past animal trials. Synthetic drugs, that are mainly or fully synthesized, are constantly in research, but often confront the iron laws of molecular science – just because we envision a molecule doesn't mean we can synthesise it easily.

Moving Quickly to Stay in Place

The prevailing expert assessment is that when it comes to antibiotics, we must run very fast indeed just to stay in the current position. Careful, globally managed deployment is the only way to maintain our therapeutic edge. Sadly, the magnitude of forthcoming discoveries is going to seem miserly in contrast to the curative bonanza of the previous century.