🔗 Share this article

During a time as head of the World Health Organization, a former leader famously stated that all of the “easy” antimicrobials had already been found. The point was that in tackling the pressing danger of antibiotic-resistant infections, we would face difficulties to find new treatments – or conserve the current arsenal – without developing new ways of working. This assessment was accurate.

A Slow and Unprofitable Pipeline

Since 2017, just 16 antibiotics have gained broad regulatory approval – primarily close relatives of drugs currently available and thus not expected to overcome resistance for an extended period. The development of novel compounds is a lengthy and unprofitable endeavor, given that curative medicines are not as profitable as ones managing chronic ailments. The overall prospect continues to be grim.

A Spark of Hope and a Novel Approach

Nevertheless, the news this month of two new regulator-approved antibiotics for gonorrhoea is good news and, crucially, validates a innovative method of incentivising development. A particular of the new drugs, Zoliflodacin, is the product of a novel kind of collaboration between a Swiss non‑profit and a drug firm. The public health partnership supplied funding and organised testing phases to defray costs and clear approval processes. This type of support upfront helps direct the industry towards areas of most pressing public health necessity.

This model and another praised “subscription model” – initiated to guarantee revenue to firms investing in specific antimicrobials – constitute the best hope of maintaining a dripfeed of novel treatments from the current framework.

The Unavoidable Challenge of Drug Resistance

But even hurrying the development of drugs in the pipeline is not sufficient. The new drug is sometimes described as a new class of antimicrobial, meaning it attacks a component of the pathogen that no other drug does, theoretically forcing the bacterium to start from zero in evolving a countermeasure to it. Scientists and physicians are relieved to have a new drug for gonorrhoea – which has resistant strains to every known antibiotic – but caution that eventual drug resistance to this compound is inevitable.

As has become the norm with new antibiotics, exists therefore an argument about whether it should be stockpiled, restricted to extremely drug-resistant cases only – confining its use to settings where high‑end lab testing is accessible. This sort of prudent strategy should be the global standard, but frequently cannot be deployed easily in many parts of the world.

A Dwindling Pipeline of Innovation

More broadly, 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 natural world for biological compounds – as with penicillin – has had diminishing returns. The application of artificial intelligence has been proposed to accelerate the discovery process, although a highly-touted early candidate identified in 2020 hasn't yet progressed past preclinical studies. Fully lab-created compounds, which are mainly or fully lab-created, are constantly in development, but often confront the iron laws of chemistry – the fact that we envision a molecule does not guarantee we can create it easily.

Running Fast to Stay in Place

The prevailing expert assessment is that when it comes to antibiotics, we must move with great speed indeed just to stay in the same place. Careful, globally managed deployment is the only way to maintain our therapeutic edge. Regrettably, the scale of future breakthroughs is likely to seem meager in contrast to the therapeutic revolution of the previous century.